| Patient 1: 23-month-old female | Patient 2: 11-month-old male |
| Symptoms | Fever, no cough over 3 weeks (despite antibiotic therapy) | Cough, no fever or weight loss over 3 weeks |
| Tests/Results | - TB skin test: Positive (POS)
- Chest x-ray (CXR): Left lung perihilar infiltrate
3 gastric aspirates (GAST):
- AFB smear: Negative (NEG)
- NAAT (PCR): POS for Mycobacterium tuberculosis (MTB)
| - TB skin test: POS
- CXR: Right apical infiltrate with lymphadenopathy
3 gastric aspirates (GAST):
- AFB smear: NEG (GAST)
- NAAT (PCR): POS for MTB
|
| Initial therapy | Isoniazid (INH), rifampin, pyrazinamide, streptomycin, ciprofloxacin (CIPRO) | Based on the father's profile (resistance to first-line antibiotics), included amikacin (AK), p-aminosalicylic acid (PAS), ethionamide (ETH), moxifloxacin (MOX), and 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 the same resistant MTB strain | Father admitted to hospital with treatment failure for MDR-TB (a week earlier) |
| Outcome | - 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.
|
16. Pinon, M., Scolfaro, C., Bignamini, E., Cordola, G., Esposito, I., Milano, R., Mignone, F., Bertaina, C., & Tovo, P. (2010). Two pediatric cases of Multidrug-Resistant tuberculosis treated with linezolid and moxifloxacin. PEDIATRICS, 126(5), e1253–e1256. https://doi.org/10.1542/peds.2009-2172
