Journal
LANCET INFECTIOUS DISEASES
Volume 15, Issue 12, Pages 1485-1491Publisher
ELSEVIER SCI LTD
DOI: 10.1016/S1473-3099(15)00356-4
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Funding
- National Institutes of Health (NIH) Director's Transformative Research Award [R01-EB020539]
- NIH Director's New Innovator Award [DP2-OD006492]
- NHLBI [R01-HL116316]
- Pediatric Infectious Diseases NIH Training grant [T32-AI052071]
- Centers for Disease Control and Prevention (Atlanta, GA, USA)
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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.
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