Journal
INFECTION AND DRUG RESISTANCE
Volume 14, Issue -, Pages 1505-1509Publisher
DOVE MEDICAL PRESS LTD
DOI: 10.2147/IDR.S304799
Keywords
latent tuberculosis infection; LTBI; treatment; acquired drug resistance; drug-resistant TB; subclinical TB; case report
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This case report highlights the importance of appropriate treatment and prompt diagnosis in eliminating tuberculosis. The patient initially diagnosed with latent tuberculosis infection later developed active TB disease with drug resistance, but showed improvement and no recurrence after individualized anti-TB treatment for 20 months. The study suggests that traditional diagnostic methods may not be sufficient to differentiate different stages of TB or LTBI.
Appropriate treatment is the key element in eliminating tuberculosis (TB), and requires prompt diagnosis. We presented a case of a household contact of rifampicin-resistant TB revealing reactive IFN-gamma release assay with unsuspicious clinical and radiologic examinations. She was diagnosed with latent tuberculosis infection (LTBI) and treated with isoniazid monotherapy. On the ninth month, she developed a progressive cough and was found to harbor active TB disease with added resistance to isoniazid. An individualized anti-TB regimen consisting of moxifloxacin, kanamycin, prothionamide, ethambutol, and pyrazinamide was prescribed for 20 months, leading to sputum culture conversion and improvement of the reported symptom. No recurrence was observed on one-year follow-up. Assuming high compliance to therapy, we propose that the patient may have been under-diagnosed and received sub-optimal treatment leading to acquired-drug resistance. Conventional diagnosis methods based on immunological assay and radiographical findings may be insufficient to distinguish the incipient and subclinical states of TB from LTBI.
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