Comparison of Italian Pediatric Cases - LabCE.com, Laboratory Continuing Education

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Comparison of Italian Pediatric Cases

	Patient 1: 23-month-old female	Patient 2: 11-month-old male
Symptoms	Fever, no cough over 3-week period (despite antibiotic therapy)	Cough, no fever or weight loss over 3-week period
Tests/Results	TB skin test: Positive (POS) Chest x-ray (CXR): Left lung perihilar infiltrate AFB smear: Negative (NEG) on 3 gastric aspirates (GAST) NAAT (PCR): POS for Mycobacterium tuberculosis (MTB)	TB skin test: POS CXR: Right apical infiltrate with lymphadenopathy AFB smear: NEG (GAST) NAAT (PCR): POS for MTB
Initial therapy	Isoniazid (INH), rifampin, pyrazinamide, streptomycin, ciprofloxacin (CIPRO)	Based on father's profile (resistance to first-line antibiotics), included amikacin (AK), p-aminosalicylic acid (PAS), ethionamide (ETH), moxifloxacin (MOX), linezolid (LNZ)
Culture & susceptibility	MTB strain resistant to second-line antibiotic kanamycin (KAN) using the BACTEC™ MGIT™ 960	MTB strain resistant to second-line ETH, PAS, and cycloserine
Adjusted therapy	ETH, MOX, PAS, and LNZ	Continued on AK, KAN, CIPRO, and LNZ
Source of infection	Lived with an aunt diagnosed with same resistant MTB strain	Father admitted to hospital with treatment failure for MDR-TB (week earlier)
Outcome	3 months in-hospital treatment; 10 months outpatient treatment. Culture & CXR negative at 1 month. Normal blood tests, eye exam, and EKG. No relapse after 18 months.	3-month susceptibility showed second-line sensitivity to AK, KAN, CIPRO, and LNZ GAST: NAAT NEG & no adverse reactions to anti-TB drugs.