A case report of a child with probable drug resistant tuberculous pericarditis with a review of challenges involved in diagnosis, treatment and follow up of children with DR-TB pericarditis

Abstract

Background: There are unique challenges in the diagnosis and management of multi drug resistant tuberculosis (MDR-TB) in children. It is difficult to obtain confirmatory microbiological diagnosis in TB pericarditis. It is essential to differentiate between drug sensitive and drug resistant forms of TB as it has a major bearing on the regimen used, and inappropriate TB treatment combined with steroid use for pericarditis can lead to deterioration. With lack of samples, the treatment decision relies on the drug resistance pattern of the close contact if available. Therapeutic challenges of MDR-TB management in a child involve use of toxic drugs that need to be judiciously handled. We report a 2 years 4 months old male child who was diagnosed with TB pericarditis and treated based on the resistance pattern of his mother who was on treatment for pulmonary MDR-TB. Case presentation: This 2 years 4 months old male child was diagnosed with TB involving his pericardium. Getting him started on an appropriate regimen was delayed due to the difficulty in establishing microbiological confirmation and drug susceptibility. He was commenced on a regimen based on his mother's drug resistance pattern and required surgery due to cardiac failure during the course of his treatment. He successfully completed 2 years of therapy. Conclusions: This child's case demonstrates that despite unique challenges in diagnosis and management of drug resistant extra pulmonary tuberculosis in children, treatment of even complex forms can be successful. The need for high suspicion of MDR-TB, especially when there is close contact with pulmonary TB, careful design of an effective regimen that is tolerated by the child, indications for invasive surgical management of pericarditis, appropriate follow-up and management of adverse effects are emphasised.

Twenty‐four‐week interim outcomes of bedaquiline‐containing regimens in treatment of adolescents with rifampicin‐resistant tuberculosis: A retrospective cohort study in China

“…It is estimated that between 25 000 and 32 000 children or adolescents suffer from RR‐TB or MDR‐TB annually, and very few of them receive the correct diagnosis and appropriate treatment 11 . Children are excluded from early TB drug development trials due to theoretical safety concerns and the desire to protect vulnerable patients.…”

“…It is estimated that between 25 000 and 32 000 children or adolescents suffer from RR-TB or MDR-TB annually, and very few of them receive the correct diagnosis and appropriate treatment. 11 Children are excluded from early TB drug development trials due to theoretical safety concerns and the desire to protect vulnerable patients. Currently available TB or DR-TB treatment might be effective for children but is limited by high pill burden, poor service delivery, an overall lack of child-friendly drug regimens, long duration of treatment and coexistent toxicities.…”

A Very Complicated Pneumonia in a 1-Year-Old Boy

“…Other manifestations of EPTB include miliary disease, extrapulmonary lymphadenopathy, skeletal disease, and pericarditis. 12,13 Standard treatment for TB involves quadruple therapy with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE). Furthermore, adjunctive corticosteroid therapy has been shown to reduce inflammation and improve outcomes in pediatric patients with primary TB complicated by bronchial obstruction and meningitis.…”

“…Other manifestations of EPTB include miliary disease, extrapulmonary lymphadenopathy, skeletal disease, and pericarditis. 12,13…”

Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now

“…It has a higher incidence of MDR-TB [ 156 , 161 ]. Case reports with MDR EPTB have been reported [ 162 , 163 ], occur more in children under one year [ 164 ], and is associated with increased mortality [ 160 ]. X-pert Ultra is preferred as a diagnostic method for EPTB and drug resistance patterns [ 165 , 166 ].…”