Comparison of Italian Pediatric Cases

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The page below is a sample from the LabCE course Tracking Antibiotic-Resistant Tuberculosis. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Comparison of Italian Pediatric Cases

Patient 1: 23-month-old femalePatient 2: 11-month-old male
  • Fever, no cough over 3-week period (despite antibiotic therapy)
  • Cough, no fever or weight loss over 3-week period
  • TB skin test: Positive (POS)
  • Chest x-ray (CXR): Left lung perihilar infiltrate

  • AFB smear: Negative (NEG) on 3 gastric aspirates (GAST)
  • NAAT (PCR): POS for Mycobacterium tuberculosis (MTB)
  • TB skin test: POS
  • CXR: Right apical infiltrate with lymphadenopathy
  • AFB smear: NEG (GAST)
  • NAAT (PCR): POS for MTB
Initial therapy
  • Isoniazid (INH), rifampin, pyrazinamide, streptomycin, ciprofloxacin (CIPRO)
  • Based on father's profile (resistance to first-line antibiotics), included amikacin (AK), p-aminosalicylic acid
    (PAS), ethionamide (ETH), moxifloxacin (MOX), linezolid (LNZ)
Culture & susceptibility
  • MTB strain resistant to second-line antibiotic kanamycin (KAN) using the BACTEC MGIT 960
  • MTB strain resistant to second-line ETH, PAS, and cycloserine
Adjusted therapy
  • ETH, MOX, PAS, and LNZ
  • Continued on AK, KAN, CIPRO, and LNZ
Source of infection
  • Lived with an aunt diagnosed with same resistant MTB strain
  • Father admitted to hospital with treatment failure for MDR-TB (week earlier)
  • 3 months in-hospital treatment; 10 months outpatient treatment. Culture & CXR negative at 1 month. Normal blood tests, eye exam, and EKG. No relapse after 18 months.
  • 3-month susceptibility showed second-line sensitivity to AK, KAN, CIPRO, and LNZ
  • GAST: NAAT NEG & no adverse reactions to anti-TB drugs.