Skip to main content

Advertisement

Log in

Multi-drug Resistant Childhood Tuberculosis

  • Symposium on Pediatric Tuberculosis
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Emergence of drug resistant tuberculosis is one of the major challenges faced by health community globally. Tuberculosis is an important cause of morbidity and mortality among children in endemic areas, yet little is known regarding epidemiology of pediatric tuberculosis and even far lesser information is available about epidemiology, diagnosis, management and treatment outcome of drug resistant tuberculosis in children. Despite limited data and difficulties in its management, drug resistant tuberculosis can be successfully treated even in resource poor settings with proper use of existing technologies. A high index of suspicion and early drug susceptibility testing is the key to early diagnosis and good treatment outcome. Difficulties in establishing the diagnosis, drug toxicities and absence of pediatric formulations add challenges to the management of Pediatric MDR TB Cases. Active research is required to answer the unresolved issues of finding optimal diagnostic tools, treatment regimens and duration and chemoprophylaxis in pediatric drug resistant tuberculosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Global tuberculosis control: a short update to the 2009 report. Geneva, World Health Organization, 2009 (WHO/HTM/TB/2009.426).

  2. Mitchison DA. Drug resistance in mycobacteria. Br Med Bull. 1984;40:84–90.

    PubMed  CAS  Google Scholar 

  3. Migliori GB, Iaco GD, Besozzi G, Centis R, Cirillo DM. First tuberculosis cases in Italy resistant to all tested drugs. Euro Surveill. 2007;12:pii=319.

    Google Scholar 

  4. Velayati AA, Masjedi MR, Farnia P, et al. Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively drug-resistant tuberculosis or totally drug-resistant strains in Iran. Chest. 2009;136:420–5.

    Article  PubMed  Google Scholar 

  5. Shah N, Richardson J, Moodley P, et al. Increasing second-line drug resistance among extensively drug-resistant tuberculosis patients in rural South Africa. 40th Union World Conference on Lung Health; Cancun, Mexico; Dec 3–7, 2009.

  6. Anti-tuberculosis drug resistance in the world. Fourth global report. Geneva, World Health Organization 2008 (WHO/HTM/TB/2008.394).

  7. Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.371).

  8. Nelson LJ, Wells CD. Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis. 2004;8:636–47.

    PubMed  CAS  Google Scholar 

  9. Consensus Statement. Formulation of guidelines for diagnosis and treatment of pediatric TB cases under RNTCP. Indian J Tuberc. 2004;51:102–5.

    Google Scholar 

  10. Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response. Geneva, World Health Organization, 2010 (WHO/HTM/TB/2010.30).

  11. Guidelines for surveillance of drug resistance in tuberculosis. Fourth WHO/ Union Global Project on Anti-Tuberculosis Drug Resistance Surveillance report. Geneva, World Health Organization, 2009 (WHO/HTM/TB/2009.422).

  12. WHO. A brief history of tuberculosis control in India. Geneva, World Health Organization, 2010 (WHO/HTM/TB/2010.4).

  13. Swaminathan S, Datta M, Radhamani MP, et al. A profile of bacteriologically confirmed pulmonary tuberculosis in children. Indian Pediatr. 2008;45:743–7.

    PubMed  Google Scholar 

  14. Schaaf HS, Marais BJ, Hesseling AC, Gie RP, Beyers N, Donald P. Childhood drug-resistant tuberculosis in the Western Cape Province of South Africa. Acta Paediatr. 2006;95:523–8.

    Article  PubMed  Google Scholar 

  15. Salazar GE, Schmitz TL, Cama R, et al. Pulmonary tuberculosis in children in a developing country. Pediatrics. 2001;108:448–53.

    Article  PubMed  CAS  Google Scholar 

  16. Mukherjee JS, Joseph JK, Rich ML, et al. Clinical and programmatic considerations in the treatment of MDR-TB in children: a series of 16 patients from Lima, Peru. Int J Tuberc Lung Dis. 2003;7:637–44.

    PubMed  CAS  Google Scholar 

  17. David HL. Probability distribution of drug-resistant mutants in unselected populations of Mycobacterium tuberculosis. Appl Microbiol. 1970;20:810–4.

    PubMed  CAS  Google Scholar 

  18. Supply P, Warren RM, Banuls AL, et al. Linkage disequilibrium between minisatellite loci supports clonal evolution of mycobacterium tuberculosis in a high tuberculosis incidence area. Mol Microbiol. 2003;47:529–38.

    Article  PubMed  CAS  Google Scholar 

  19. Cox HS, Niemann S, Ismailov G, et al. Risk of acquired drug resistance during short-course directly observed treatment of tuberculosis in an area with high levels of drug resistance. Clin Infect Dis. 2007;44:1421–7.

    Article  PubMed  CAS  Google Scholar 

  20. Espinal MA, Kim SJ, Suarez PG, et al. Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA. 2000;283:2537–45.

    Article  PubMed  CAS  Google Scholar 

  21. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.361).

  22. Schaaf HS, Shean K, Donald PR. Culture confirmed multidrug-resistant tuberculosis: diagnostic delay, clinical features and outcome. Arch Dis Child. 2003;88:1106–11.

    Article  PubMed  CAS  Google Scholar 

  23. Schaaf HS, Gie RP, Beyers N, Sirgel FA, de Klerk PJ, Donald PR. Primary drug resistant tuberculosis in children. Int J Tuberc Lung Dis. 2004;4:1149–55.

    Google Scholar 

  24. Drobac PC, Mukherjee JS, Joseph JK, et al. Community based therapy for children with multidrug resistant tuberculosis. Pediatr. 2006;117:2022–9.

    Article  Google Scholar 

  25. Fishman JE, Sais GJ, Schwartz DS, Otten J. Radiographic findings and patterns in multidrug-resistant tuberculosis. J Thorac Imaging. 1998;13:65–71.

    Article  PubMed  CAS  Google Scholar 

  26. Feng-zeng Z, Levy MH, Sumin W. Sputum microscopy results at two and three months predict outcome of tuberculosis treatment. Int J Tuberc Lung Dis. 1997;1:570–2.

    Google Scholar 

  27. Akira M, Sakatani M, Ishikawa H. Transient radiographic progression during initial treatment of pulmonary tuberculosis: CT findings. J Comput Assist Tomogr. 2000;24:426–31.

    Article  PubMed  CAS  Google Scholar 

  28. Mitnick C, Bayona J, Palacios E, et al. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med. 2003;348:119–28.

    Article  PubMed  Google Scholar 

  29. Mitnick C, Shin S, Seung K, et al. Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med. 2008;359:563–74.

    Article  PubMed  CAS  Google Scholar 

  30. Feja K, McNelley E, Tran C, Burzynski J, Saiman L. Management of pediatric multidrug-resistant tuberculosis and latent tuberculosis infections in New York City from 1995 to 2003. Pediatr Infect Dis J. 2008;27:907–12.

    Article  PubMed  Google Scholar 

  31. Schluger N, Lawrence R, McGuiness G, Park M, Rom W. Multidrug-resistant tuberculosis in children: two cases and a review of the literature. Pediatr Pulmonol. 1996;21:138–42.

    Article  PubMed  CAS  Google Scholar 

  32. Rastogi N, Labrousse V, Goh KS. In vitro activities of fourteen antimicrobial agents against drug susceptible and resistant clinical isolates of Mycobacterium tuberculosis and comparative intracellular activities against the virulent H37Rv strain in human macrophages. Curr Microbiol. 1996;33:167–75.

    Article  PubMed  CAS  Google Scholar 

  33. Centre For Disease Control and Prevention. Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controller Association and CDC. MMWR. 2005;54:1–47.

    Google Scholar 

  34. Fraser A, Paul M, Attamno A, Leibovici L. Drugs for preventing tuberculosis in people at risk of multiple drug resistant tuberculosis. Cochrane Database Syst Rev. 2006;2:CD005435.

    PubMed  Google Scholar 

  35. Schaaf HS, Gie RP, Kennedy M, Beyers N, Hesseling PB, Donald PR. Evaluation of young children in contact with adult multidrug resistant pulmonary tuberculosis: a 30 month follow up. Pediatr. 2002;109:765–71.

    Article  Google Scholar 

  36. Kritski AL, Marques MJ, Rabahi MF, et al. Transmission of tuberculosis to close contacts of patients with multidrug resistant tuberculosis. Am J Respir Crit Care Med. 1996;153:331–3.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Varinder Singh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, V., Kaur, S. Multi-drug Resistant Childhood Tuberculosis. Indian J Pediatr 78, 456–463 (2011). https://doi.org/10.1007/s12098-010-0344-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-010-0344-2

Keywords

Navigation