Slow Response to Anti-tuberculosis Drug in a 12-year Old Girl: Is it Multi Drug Resistant Tuberculosis or Paradoxical Response?

Heda Melinda^1, and Minerva Kadir¹

¹Department of Child Health Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia

Cite this paper

Heda Melinda and Minerva Kadir. Slow Response to Anti-tuberculosis Drug in a 12-year Old Girl: Is it Multi Drug Resistant Tuberculosis or Paradoxical Response?. American Journal of Medical Case Reports. 2015; 3(10):344-346. doi: 10.12691/AJMCR-3-10-10

Abstract

Clinical deterioration during treated with anti-tuberculosis drug (ATD) is not common occured in immunocompetent children, remains a great dilemma. It requires medical attention, practitioners should be considered as multi-drug resistant tuberculosis (MDR-TB) or paradoxical response. We report a challenging case of a-12-year-old girl presented with clinical deterioration severe respiratory distress transferred to isolated pediatric intensive care unit while on TB treatment. On admission, chest X-ray revealed pneumothorax in left lung and bilateral pulmonary infiltration. During evalution, she had seizure and decreased consciousness, and later diagnosed as as tuberculous meningitis (TBM). She had close contact with her acid–fast bacillus (AFB)–positive, Gene Xpert MTB/RIF negative-mother. Five other siblings were diagnosed as having TB as well. The patient was first suspected as having MDR-TB, while Gene Xpert MTB/RIF test revealed still positive. The patient then showed good clinical improvement after TB treatment.

Keywords

tuberculosis, MDR-TB, paradoxical response, Gene Xpert MTB/RIF

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Silva DR, Gazzana MB, Dalcin TR. Severe tuberculosis requiring ICU admission. J Bras Pneumol. 2012;38(3):386-94.
[2]	Marais BJ. Childhood tuberculosis: epidemiology and natural history of disease. Indian J Pediatr. 2011;78:321-27.
[3]	Pinon I, Scolfaro C, Bignamini E, et al. Two pediatric cases of multidrug-resistant tuberculosis treated with linezolid and moxifloxacin. Pediatr. 2010;126:1253-56.
[4]	Ramachandran G, Kumar AK, Bhavani PK, et al. Age, nutritional status and INH acetylator status affect pharmacokinetics of anti-tuberculosis drugs in children. Int J Tuberc Lung Dis. 2013;17(6):800-6.
[5]	Shah I, Borse S. Paradoxical tuberculomas after completion of antituberculous treatment. Trop Med Health. 2012;40(1):15-7.
[6]	Cheng VCC, Ho PL, Lee RA, et al. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non hiv infected patients. Eur J Clin Microbiol Infect Dis. 2002;21:803-9.
[7]	Park JA, Park SS, Park SE. A paradoxical reaction during antituberculosis therapy for congenital tuberculosis. Int J Infect Dis. 2009;13:279-81.
[8]	Cheng VCC, Yam WC, Woo PCY, et al. Risk factors for development of paradoxical response during antituberculosis therapy in hiv-negative patients. Eur J Clin Microbiol Infect Dis. 2003;22:597-602.
[9]	Cruz AT, Hwang KM, Birnbaum GD, et al. Adolescents With Tuberculosis A review of 145 cases. Pediatr Infect Dis J 2013;32:937-41.
[10]	Valade S, Raskine L, Aout M, et al. Tuberculosis in the intensive care unit: A retrospective descriptive cohort study with determination of a predictive fatality score. Can J Infect Dis Med Microbiol 2012;23(4):173-78.
[11]	Cheng VC, Ho PL, Lee RA, Chan KS, Chan KK, Woo PC, Lau SK, Yuen KY. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis. 2002;21(11):803-9.
[12]	Park JA, Park SS, Park SE. A paradoxical reaction during antituberculosis therapy for congenital tuberculosis. Int J Infect Dis 2009;13:279-81.
[13]	Gray D, Zar HJ. Childhood pneumonia in low and middle income countries: burden, prevention and management. Open Infect Dis J. 2010;4:74-84.
[14]	Avdeeva T, Otvagin I, Myakisheva T, et al. Tuberculosis in adolescents and young patients in high prevalence region. Eur J Microbiol Immunol. 2012;4:297-301.
[15]	Berti E, Galli L, Venturini E, et al. Tuberculosis in childhood: a systematic review of national and international guidelines. BMC Infect Dis. 2014;4:1-10.
[16]	Marx G, Chan ED. Tuberculous meningitis: diagnosis and treatment overview. Hindawi 2011:1-10.
[17]	Nicol MP, Workman L, Isaacs W, et al. Accuracy of the Xpert MTB/RIF test for the diagnosis of pulmonary tuberculosis in children admitted to hospital in Cape Town, South Africa: a descriptive study. Lancet Infect Dis. 2011; 11: 819-24.
[18]	Perez-Velez CM, Marais BJ. Current concepts tuberculosis in children. N Engl J Med. 2012;367:348-61.
[19]	Olive C, Mouchet F, Toppet V, et al. Paradoxical reaction during tuberculosis treatment in immunocompetent children: Clinical spectrum and risk factors. Pediatr Infect Dis J. 2013;32:446–49.
[20]	Graham SM. Treatment of paediatric TB: revised WHO guidelines. Paed Resp Rev. 2011;12:22-6.
[21]	Hawkey CR, Yap T, Pereira J, et al. Characterization and management of paradoxical upgrading reactions in hiv-uninfected patients with lymph node tuberculosis. Clin Infect Dis. 2005;40:1368-71.
[22]	Ali U, Chikar S, Patil M, et al. Acute respiratory distress during paradoxical reaction to antitberculosis therapy in an 8 month old child. Lung India. 2012;29:381-3.
[23]	Nicolette NB, Jo W, Muloiwa R, et al. Presentation and outcome of tuberculous meningitis among children: experiences from a tertiary children’s hospital. Afr Health Sci. 2014;14(1):143-9.