An 11-month-old boy with a persistent cough but no fever or weight loss over three weeks was admitted to the hospital for possible pulmonary tuberculosis (TB). His family had emigrated from Moldova (Eastern Europe) two years before, and his father had been admitted to another hospital just a week earlier after treatment failure for pulmonary multidrug-resistant TB (MDR-TB).
- The child had a positive skin test, and the chest x-ray showed a right apical infiltrate with hilar adenopathy (lymphadenopathy).
- The results of gastric aspirates were acid-fast bacilli (AFB) smear-negative, but nucleic acid amplification tests (NAATs) were positive.
- Based on his father’s susceptibility profile (resistance to all first-line anti-TB drugs), physicians started combined treatment for the child with amikacin (AK), p-aminosalicylic acid (PAS), ethionamide (ETH), moxifloxacin (MOX), and linezolid (LNZ), pending the father’s susceptibility tests to second-line drugs. The child did not receive antibiotic therapy before hospitalization.
Three months after beginning the child’s treatment, results showed that the second-line drugs AK, kanamycin, and ciprofloxacin (CIPRO) were susceptible. Resistant drugs included ETH, PAS, and cycloserine. However, the father was untraceable then, and public health officials could not locate any family members. Fortunately, the child had three NAAT-negative gastric aspirates after two months of the anti-TB drugs with no adverse reactions.
15. 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
