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[Tuberculosis: a forgotten challenge]
Insights
This case study highlights a vulnerable child with disseminated, multidrug-resistant tuberculosis (MDR-TB). The severe illness and complications underscore the risks of TB transmission from adults to children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health challenge despite over a century since its causative agent's discovery.
- Pediatric TB, particularly disseminated forms, presents unique diagnostic and therapeutic difficulties.
Observation:
- A case of a 3.5-month-old infant hospitalized with fever, malnutrition, opisthotonos, and hepatosplenomegaly is presented.
- The infant was diagnosed with disseminated tuberculosis affecting the central nervous system.
Findings:
- Treatment with five antituberculosis drugs and corticosteroids was initiated, with initial respiratory improvement.
- The patient developed a seizure, hydrocephalus requiring a shunt, and gastric aspirate revealed Mycobacterium tuberculosis resistant to isoniazid and streptomycin.
- At eight months, the child exhibited severe psychomotor retardation, ongoing treatment with three drugs, and the presence of a shunt.
Implications:
- This case underscores the vulnerability of children in high-risk groups to severe, multidrug-resistant tuberculosis (MDR-TB).
- It highlights the critical need for early diagnosis and effective treatment strategies for pediatric TB.
- The case illustrates the potential for TB transmission from infected adults to vulnerable infants within families.
Abstract:
Tuberculosis continues to be a serious problem in public health even thought eh causative bacillus was discovered over 100 years ago. The authors present a clinical case that illustrates the current concern regarding the disease. The case concerns a child of emigrant parents, who are drug addicts and whose illness has not been fully ascertained. The child was hospitalised at three and an half months with fever, malnutrition, opisthotonos and hepatosplenomegaly. After the diagnosis of disseminated tuberculosis affecting the central nervous system, treatment was started with five antituberculosis drugs and with corticosteroids. Respiration improved favourably, but after 19 days the patient suffered a partial tonic-clonic seizure. Subsequently, hydrocephalus was observed and a shunt was applied. Bacteriological examination of the gastric aspirate showed a strain of Mycobacterium tuberculosis resistant to isoniazid and streptomycin. In the eight month of therapeutics, three antituberculosis drugs were still being administered, the shunt was still present and the patient showed a severe psychomotor retardation. The child belonged to a risk group and presented a serious form of tuberculosis with multidrug-resistance, illustrating that this group of children is particularly vulnerable and reflect transmission of this illness among adults.