Drug resistant TB

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Drug resistant TB

Author: Pediatric Oncall

Question
A 4 year old boy was referred for non-healing pulmonary TB.
Past History: He was diagnosed to have pulmonary TB at the age of 2 years. His gastric lavage for acid fast bacillus was positive at that time. He was treated with 4 drug antituberculous therapy (ATT) consisting of Isoniazid (H), Rifampicin (R), Ethambutol (E) and Pyrazinamide (Z) for 2 months followed by 3 drug ATT of HRE for 7 months. His Chest X-Ray however continued to show bilateral mid and lower zone haziness and he had failure to thrive (weight = 8 kg at 3 years). He was then treated with 6 drug ATT consisting of Ofloxacin (Ofx) and Streptomycin (Sm) additionally. Sm, Ofx, Z were stopped after 4 months and HRE were continued. However, there was no clinical or radiological improvement.
Present History: Presently the child had cough and evening rise of temperature. There was no history of contact with TB. His HIV ELISA test was negative. On examination, he was cachetic, had bronchial breathing on right infraclavicular region with bilateral crepitations. Chest X-Ray showed right upper lobe cavity with bilateral mid and lower zone pneumonitis. The child’s sputum for acid fast bacillus was positive.

How should this child be treated?

Answer Discussion :

J

Julio César Neyra Pinto

0

We have make a geneXpert lab study in order to exclude multidrug resistant tb

S

Shanthi Ananthakrishnan

0

Sensitivity to 2nd line of ATT drugs should be done and child treated accordingly. BAL should be doe and the specimen sent for both tuberculosis and other pathogens.

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Answer 1

This child has open TB (cavitatory TB) which has not responded to regular as well as additional antituberculous drugs. Hence, it most likely to be multi-drug resistant TB (MDR TB). Ideally, a CBNAAT and TB MGIT culture and sensitivity of the sputum would be recommended and drugs then dispensed accordingly. We must treat the child with 2nd line drugs with at least 5 sensitive drugs for 18-24 months.

Drug resistant TB

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