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

Nicole Salazar-Austin; Alvaro A Ordonez; Alice Jenh Hsu; Jane E Benson; Mahadevappa Mahesh; Elizabeth Menachery; Jafar H Razeq; Max Salfinger; Jeffrey R Starke; Aaron M Milstone; Nicole Parrish; Eric L Nuermberger; Sanjay K Jain

doi:10.1016/S1473-3099(15)00356-4

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

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

Authors

Affiliations

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.

Publication types

Case Reports
Research Support, N.I.H., Extramural
Review

MeSH terms

Antitubercular Agents / therapeutic use
Child, Preschool
Extensively Drug-Resistant Tuberculosis / diagnosis*
Extensively Drug-Resistant Tuberculosis / diagnostic imaging
Extensively Drug-Resistant Tuberculosis / drug therapy
Extensively Drug-Resistant Tuberculosis / microbiology
Female
Humans
India
Mycobacterium tuberculosis / pathogenicity
Mycobacterium tuberculosis / physiology
Pneumonia, Bacterial / diagnosis*
Pneumonia, Bacterial / diagnostic imaging
Pneumonia, Bacterial / drug therapy
Pneumonia, Bacterial / microbiology
Radiography
Travel
Tuberculosis, Pulmonary / diagnosis*
Tuberculosis, Pulmonary / diagnostic imaging
Tuberculosis, Pulmonary / drug therapy
Tuberculosis, Pulmonary / microbiology
United States

Substances

Antitubercular Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding