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Lancet Infect Dis. 2015 Dec;15(12):1485-91. doi: 10.1016/S1473-3099(15)00356-4. Epub 2015 Nov 16.

Extensively drug-resistant tuberculosis in a young child after travel to India.

Author information

1
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
3
Department of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
4
Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
5
Howard County Health Department, Columbia, MD, USA.
6
Maryland Department of Health and Mental Hygiene, Laboratories Administration, Baltimore, MD, USA.
7
National Jewish Health Mycobacteriology Laboratory, Denver, CO, USA.
8
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
9
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
10
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
11
Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
12
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: sjain5@jhmi.edu.

Abstract

Extensively drug-resistant (XDR) tuberculosis is becoming increasingly prevalent worldwide, but little is known about XDR tuberculosis in young children. In this Grand Round we describe a 2-year-old child from the USA who developed pneumonia after a 3 month visit to India. Symptoms resolved with empirical first-line tuberculosis treatment; however, a XDR strain of Mycobacterium tuberculosis grew in culture. In the absence of clinical or microbiological markers, low-radiation exposure pulmonary CT imaging was used to monitor treatment response, and guide an individualised drug regimen. Management was complicated by delays in diagnosis, uncertainties about drug selection, and a scarcity of child-friendly formulations. Treatment has been successful so far, and the child is in remission. This report of XDR tuberculosis in a young child in the USA highlights the risks of acquiring drug-resistant tuberculosis overseas, and the unique challenges in management of tuberculosis in this susceptible population.

PMID:
26607130
PMCID:
PMC4843989
DOI:
10.1016/S1473-3099(15)00356-4
[Indexed for MEDLINE]
Free PMC Article

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