BACKGROUND
Tuberculosis in children under 15 years old is accounted for 15% of all cases in developing countries. Multidrug resistant tuberculosis (MDR-TB) emerges as a new problem in managing children with TB. It was estimated the annual incident cases of pediatric MDR-TB reached 32.000 cases. Suspicion of MDR-TB is based on a close contact with an adult with MDR-TB, relapsing TB during 6-12 months, failure on first line therapy in 2-3 months, or close contact with patient died due to TB or failed TB therapy.
CASE PRESENTATION
There were three reported cases of MDR-TB in Cipto Mangunkusumo Hospital in the last 2018. The first case is a 15 years old girl with a history of completed therapy of lung TB one year prior to admission. She had a TB contact adult but not MDR-TB. The second case was a 12 years old girl with a history of completed therapy lymphadenitis TB. Two years after completion therapy, she was diagnosed from immune thrombocytopenia (ITP) and got 2 months immunosuppressant therapy. The last case was a 16 years old marasmic malnutrition boy with chronic kidney disease with regular hemodialysis. The last 2 cases had no clear contact history with TB or MDR-TB adults but in high risk of contact due to frequent visit to health care facilities. Moreover, they got long-term immunosuppressant therapy. These three cases were diagnosed with MDR-TB from Gene Xpert examination, which were found to be rifampicin resistant.
CONCLUSION
The increasing cases of MDR-TB are major threat to pediatric health condition. Of the three above MDR-TB cases are adolescents. No clear contact to MDR-TB adults does not rule out the possibility of pediatric MDR-TB especially in high risk child. Relapsing TB must also be taken into consideration. Physician should be aware of these distinct conditions.