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Case Study of Drug Resistance in Two Children: Patient 2

An 11-month-old boy with a persistent cough, but no fever or weight loss over a 3 week period was admitted to the hospital for possible pulmonary tuberculosis (TB). His family had emigrated from Moldova (Eastern Europe) two years before and his father had been admitted to another hospital just a week earlier after treatment failure for pulmonary multidrug-resistant TB (MDR-TB). The child had a positive skin test and the chest x-ray showed a right apical infiltrate with hilar adenopathy (lymphadenopathy). Secondly, results of gastric aspirates were acid-fast bacilli (AFB) smear negative, but nucleic acid amplification tests (NAATs) were positive. Based on his father’s susceptibility profile (resistance to all first-line anti-TB drugs), physicians started combined treatment for the child with amikacin (AK), p-aminosalicylic acid (PAS), ethionamide (ETH), moxifloxacin (MOX), and linezolid (LNZ), pending the father’s susceptibility tests to second-line drugs. The child did not receive antibiotic therapy prior to hospitalization.
Three months after beginning the child’s treatment, results showed that the second-line drugs AK, kanamycin, and ciprofloxacin (CIPRO) were susceptible. Resistant drugs included ETH, PAS, and cycloserine. However, at that time, the father was untraceable and public health officials were unable to locate any members of the family. Fortunately, the child had three NAAT negative gastric aspirates after two months of the anti-TB drugs with no adverse reactions.