Table 3.
Diagnosis, management and outcomes of pediatric XDR-TB cases
| Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
| Sputum smear result* | Positive on 2nd specimen | Positive on 4th specimen | All 5 specimens negative | All 2 specimens negative |
| Culture result* | Positive on 1st specimen | Positive on 3rd specimen | Positive on 3rd specimen | Positive on 2nd specimen |
| DST result | All resistant to INH, RMP, SM, EMB, CFX, KM | |||
| Time to DST result, weeks† | 10 | 6 | 13 | 7.5 |
| Chest radiograph findings at time of XDR-TB diagnosis | Right ML infiltrate and right UL cavity | Extensive bilateral infiltrates | Left UL/LL infiltrates; right perihilar lymphadenopathy | Left UL/LL consolidation |
| Intensive phase regimen | Backbone of ETH, PAS, PZA, CS, CM | |||
| EMB, CLA,‡ AM/CL‡ | CLA, AM/CL | EMB, CLA, AM/CL | EMB, CLA, AM/CL | |
| Time to culture conversion, weeks§ | 13¶ | 13¶ | 5¶ | 8¶ |
| Medication side effects | None | None | Acute psychosis, likely due to CS and efavirenz | Behavioral changes due to CS |
| Weight gain, kg# | 4.8 | 6.0 | 6.0 | 2.8 |
| Change in CD4 count in cells/mm3 (% change in lymphocytes)** | +356 (+7.1) | (+6.0) | Baseline data not available | +60 (+6.0) |
| 24-month survival | Alive with mild bronchiectasis | Thriving | Thriving | Alive with bronchiectasis and chronic lung disease |
| XDR-TB treatment outcome | Cured | Cured | Cured | Cured |
Specimens obtained prior to initiation of XDR-TB treatment.
Interval between date of diagnostic sputum sample collection and receipt of DST results showing XDR-TB.
Added during month 5 of treatment due to impending drug shortages.
Culture conversion: 2 successive months of sputum cultures without growth of Mycobacterium tuberculosis while on XDR-TB treatment.
Initial culture conversion; Cases 1 and 2 had relapse of XDR-TB following initial culture conversion after defaulting from treatment; Cases 2–4 had an isolated positive sputum culture after culture conversion while remaining on full treatment, then re-converted to negative.
Weight gain: measured as difference in weight over 24-month survival period.
Measured after 7–15 months of initiating HAART, based on available data.
XDR-TB = extensively drug-resistant tuberculosis; DST = drug susceptibility testing; INH = isoniazid; RMP = rifampin; SM = streptomycin; EMB = ethambutol; CFX = ciprofloxacin; KM = kanamycin; ML = middle lobe; UL = upper lobe; LL = lower lobe; ETH = ethionamide; PAS = para-aminosalicylic acid; PZA = pyrazinamide; CS = cycloserine; CM = capreomycin; CLA = clarithromycin; AM/CL = amoxicillin/clavulanate.