| Patient 1: 23-month-old female | Patient 2: 11-month-old male |
| Symptoms | - Fever, no cough over 3-week period (despite antibiotic therapy)
| - Cough, no fever or weight loss over 3-week period
|
| 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 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 | | - 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)
|
| 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.
|
