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Comparison of Italian Pediatric Cases
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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.
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