Objective: Tuberculosis (TB) is the ninth leading cause of death worldwide and Indonesia is one of high TB burden countries. Multidrug-resistant TB (MDR-TB) remains a continuing threat with an estimated 30.000 children with MDR-TB each year. However, only less than 5% receive appropriate treatment. Selecting a second-line anti-TB regimen is challenging particularly among very young patient, considering its safety. We reported a rare case of congenital MDR-TB in a young infant and highlight the initial management and regimen consideration.
Case: A 2-month-old baby girl presented to regional hospital with 7 days of high fever, cough, and progressive dyspnea. On investigation, her chest X-rays showed wide spread patchy infiltrates at both lungs. Xpert MTB/RIF assay from gastric lavage specimen confirmed low detected MTB and Rif resistance. She was referred to Dr. Kariadi Hospital for further management. On admission, gastric lavage sample was sent for line probe assays (LPA), culture and drug susceptibility testing (DST). She was started on a regimen for her presumptive MDR-TB with Levofloxacin, Linezolid, Clofazimine, Cycloserine, and Ethambutol. Thyroid function test, electrocardiogram, echocardiogram, hearing test with Otoacustic Emissions, and ophthalmology examination were done as baseline data prior to starting the treatment. The baby was born full-term with low birth weight (2100 g) from a G2P0A1, 19-year-old mother, via caesarean section due to oligohydramnion. She had severe asphyxia and anemia at birth and admitted to perinatal unit for 3 weeks. The baby never had any contact with her mother since birth and never been breastfed. One week after her mother was discharged, she was re-admitted and found to have miliary TB from clinical findings and chest X-rays. However, her mother died after 7 days of hospitalization.
Conclusion: Regimen design consideration in managing children with MDR-TB needs individual approach. Early initiation of appropriate treatment is crucial to ensure good outcome.