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

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.

Microglia activation in a pediatric rabbit model of tuberculous meningitis

“…This is a substantial increase from the prior WHO (2014) estimation, and represents the challenges of diagnosing TB in children, which is rarely bacteriologically confirmed (Salazar-Austin et al, 2015). TB meningitis continues to be associated with high morbidity and mortality in young children.…”

Successful cure of extensively drug-resistant pulmonary tuberculosis in a young child

“…1 She has been closely followed for two years after completing 18 months of directly observed therapy with an individualized drug regimen including streptomycin (first 6 months), linezolid, para-aminosalicylic acid, cycloserine and clofazimine. In the absence of clinical or microbiological markers, low-radiation exposure computed tomography (CT) was used as a rapid biomarker to guide treatment.…”

“…Each chest CT in this child was equivalent to three-months of natural background radiation, or a single screening mammogram, or four trans-Atlantic airplane round-trips. 1 Interestingly, the mortality risk for (adult) patients with MDR- and XDR-TB on treatment is similar to that due to cancers, 5 where expensive technologies, including advanced imaging continues to be routinely utilized. Therefore, we need to practice pragmatism regarding the potential risks and benefits of emerging technologies, especially when dealing with drug-resistant infections.…”

A challenging entanglement: health care providers’ perspectives on caring for ill and injured tourists on Cozumel Island, Mexico

“…Typically, studies track specific spatio-temporal disease, illness and injury vectors that commonly affect tourist populations (e.g., Chen, Chang, & Chen, 2014; Leshem et al, 2016; Ratnam, Leder, Black, & Torresi, 2013), and discuss associated pathological concerns (e.g., Flores, Hickey, Fields, & Ottolini, 2015; Matteelli, Centis, Sulis, & Tadolini, 2016; Salazar-Austin et al, 2015). Comprehensive statistical data about tourists’ use of health care abroad and their health outcomes is, however, mostly sparse and dated (Angelo, Kozarsky, Ryan, Chen, & Sotir, 2017).…”