UNSUSPECTED FATAL DRUG-RESISTANT TUBERCULOSIS IN A CLOSELY MONITORED CHILD: A PLEA FOR IMPROVED SOURCE-CASE TRACING AND DRUG SUSCEPTIBILITY TESTING.

The Southern African journal of epidemiology & infection : official journal of the Sexually Transmitted Diseases, Infectious Diseases and Epidemiological Societies of Southern Africa Pub Date : 2010-01-01

Steve Innes, H Simon Schaaf, Kim Gp Hoek, Helena Rabie, Mf Cotton

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Abstract

We report a case of rapidly progressive miliary tuberculosis in a 21-month old HIV-infected girl exposed to tuberculosis, despite early access to highly active antiretroviral therapy and proven adherence to isoniazid chemoprophylaxis. Post mortem revealed multidrug-resistant tuberculosis. This case report illustrates the consequences of inadequate programmatic management of children exposed to an adult case of sputum smear-positive multidrug-resistant tuberculosis. Drug susceptibility testing of the adult source case should become standard of care for all children who have been in close contact with a case of sputum smear-positive tuberculosis, and the choice of chemoprophylactic agents should be based on the sensitivities of the source case organism.

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在密切监测的儿童中发现未预料到的致命耐药结核病:呼吁改进源病例追踪和药敏试验。

我们报告一个21个月大的艾滋病毒感染女孩暴露于结核病，尽管早期获得高活性抗逆转录病毒治疗和证明坚持异烟肼化学预防，但迅速进展的军性结核病病例。尸检显示为耐多药结核病。本病例报告说明了对接触痰涂片阳性耐多药结核病成人病例的儿童规划管理不当的后果。成人源病例的药敏试验应成为与痰涂阳结核病例密切接触的所有儿童的护理标准，化学预防药物的选择应基于源病例微生物的敏感性。

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The Southern African journal of epidemiology & infection : official journal of the Sexually Transmitted Diseases, Infectious Diseases and Epidemiological Societies of Southern Africa

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