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Publication: When to start treatment? Dilemma illustrated by a paediatric case of extensively drug-resistant tuberculosis of the central nervous system
Gigi, R.M.S. Rieder, H.L. Padayatchi, N.
Gigi, R.M.S.
Rieder, H.L.
Padayatchi, N.
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Abstract
An HIV-positive mother infected her daughter with extensively drug-resistant Mycobacterium tuberculosis. Despite adhering to the then current guidelines for prevention, the infant was diagnosed with extensively drug-resistant pulmonary tuberculosis at the age of 4 months and developed tuberculous meningitis. After a short delay, appropriate treatment was initiated, followed by an inhospital stay at a specialised hospital. The infant became generally well, but had delayed neurological development. Secondary hydrocephalus due to tuberculous meningitis required a ventriculoperitoneal shunt. After 2 years of microbiologically and clinically effective tuberculosis treatment and several shunt complications, the HIV-negative child died at the age of 28 months ‒ with radiological signs of a shunt infection. The reason for the fatal outcome was probably related to inadequate risk reduction of airborne mother-to-child transmission, inappropriate chemoprophylaxis and delayed initiation of adequate treatment.
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Date
2020-08-31
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South African Medical Journal
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Keywords
Paediatric tuberculosis,Central nervous system,Meningeal,Extensive drug resistance,South Africa
Citation
Gigi RMS, Rieder HL, Padayatchi N. When to start treatment? Dilemma illustrated by a paediatric case of extensively drug-resistant tuberculosis of the central nervous system. South African Medical Journal 2020;110(9):846-849. doi:10.7196/SAMJ.2020.v110i9.14567