Disseminated tuberculosis in an HIV-infected child: rifampicin resistance detected by GeneXpert in a lymph node aspirate but not in cerebrospinal fluid

BMJ Case Rep. 2015 Aug 3:2015:bcr2014207997. doi: 10.1136/bcr-2014-207997.

Abstract

A 9-year-old HIV-infected child previously treated with inadequate doses of antitubercular drugs based on weight was admitted 5 months after initial tuberculosis (TB) diagnosis with acute hemiplegia and inguinal lymphadenopathies in a rural hospital in Tanzania. He was diagnosed with TB meningitis and lymphadenitis using Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay. Rifampicin resistance was detected in the lymph node aspirate but not in the cerebrospinal fluid. His TB therapy was optimised based on available medications and antiretroviral treatment was initiated 6 weeks later. Despite these efforts, the clinical evolution was poor and the child died 12 weeks after admission.

Publication types

  • Case Reports

MeSH terms

  • Anti-HIV Agents / therapeutic use
  • Antibiotics, Antitubercular* / therapeutic use
  • Child
  • DNA, Bacterial / analysis
  • Drug Resistance, Bacterial*
  • Fatal Outcome
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Hemiplegia / etiology
  • Hemiplegia / microbiology
  • Humans
  • Lymph Nodes*
  • Lymphadenitis / etiology
  • Lymphadenitis / microbiology
  • Male
  • Meningitis / etiology
  • Meningitis / microbiology
  • Mycobacterium tuberculosis* / drug effects
  • Mycobacterium tuberculosis* / genetics
  • Mycobacterium tuberculosis* / growth & development
  • Rifampin* / therapeutic use
  • Tuberculosis, Multidrug-Resistant* / complications
  • Tuberculosis, Multidrug-Resistant* / drug therapy
  • Tuberculosis, Multidrug-Resistant* / microbiology

Substances

  • Anti-HIV Agents
  • Antibiotics, Antitubercular
  • DNA, Bacterial
  • Rifampin