Multidrug-Resistant Tuberculosis in an Adult with Cystic Fibrosis

Abstract

Mycobacterium tuberculosis infection in patients with cystic fibrosis (CF) is rare. We report a 22-year-old CF patient with high fever, dyspnea and weight loss that progressively worsened over 2 weeks before admission. The patient suffered from liver cirrhosis, was colonized with Pseudomonas aeruginosa and had been repeatedly hospitalized for pulmonary infections. The patient was treated initially as for an exacerbation of P. aeruginosa infection, but tuberculosis (TBC) was suspected due to lack of improvement. A CT of the chest revealed enlarged bilateral cavities in the upper and middle lobes. A tuberculin skin test was positive, and M. tuberculosis nucleic acid was isolated from sputum samples. After receiving first-line anti-TBC drugs for 1 month, the patient's condition continued to worsen so molecular drug susceptibility testing was performed. Multidrug-resistant TBC was discovered, leading to a change in regimen. The patient was treated with ethionamide, moxifloxacin, linezolid, amikacin, imipenem/cilastatin and rifabutin and showed a remarkable clinical improvement. Although nontuberculous mycobacteria are more common in CF, the possibility of TBC should not be ignored. In that setting, early suspicion of infection due to resistant M. tuberculosis can be life saving.

Inherited and acquired immunodeficiencies underlying tuberculosis in childhood

“…BCG infection has never been reported in these patients, even in countries with mandatory BCG vaccination policies and a relatively high prevalence of CF, such as France. Infections with M.tb have been reported, mostly in adults but also, more rarely, in children . Overall, changes in the integrity of the lung may increase susceptibility to mycobacterial infections, including TB.…”

Prevalence and drug resistance of mycobacteria in Turkish cystic fibrosis patients

“…There is little information about pulmonary tuberculosis in CF patients, and only a few cases have been published [ 2 - 8 ]. The isolation rates of MTBC from respiratory samples of these patients were reported as 1.34-3.41% [ 3 , 6 , 7 ].…”

“…Two of these strains were susceptible to pyrazinamide, while one strain was resistant. In the case report by Manika et al [ 8 ] the strain was found resistant to streptomycin, isoniazid, rifampicin, ethambutol, pyrazinamide and quinolones, while it was susceptible to amikacin, kanamycin and capreomycin. In the current study all of MTBC isolates were found to be susceptible to streptomycin, isoniazid, rifampicin, and ethambutol.…”

“…Infection with Mycobacterium tuberculosis complex (MTBC) strains in this patient group is rarely reported (1.34-3.41%) [ 2 - 8 ]. These patients are at an increased risk of pulmonary colonization with opportunistic microorganisms.…”

“…There is only two reports about multidrug resistant tuberculosis in this patient group. Two M. tuberculosis strains which were isolated from two patients with pulmonary infection, found to be resistant to all antibiotics [ 2 , 8 ].…”