Toddler, 2, Returns From India With Rare Case Of Tuberculosis, Highlights Concerns Of Drug-Resistant TB Strains

A two-year-old child who had just returned from a visit to India was diagnosed with a rare form of tuberculosis despite testing negative for TB using traditional testing methods. The drug-resistant strain, XDR-TB, is a global threat, as it is impossible to treat with common TB drugs, and is hard to diagnose, as a simple skin test does not identify the strain.

The toddler was one of a handful of children in the United States that has ever been diagnosed with the deadly disease, giving doctors at Johns Hopkins Children’s Center the rare chance to report on a successfully treated child. The child required three months of treatments even with all of the resources available to doctors at the prestigious children’s hospital. Therefore, it was acknowledged by staff how deadly the disease would be in a country without access to the same sort of care.

TB
TB is now the deadliest infectious disease beating HIV/AIDS. (Photo by Feng Li/Getty Images)

The Washington Post reports that doctors at Johns Hopkins Children’s Center are calling for more creative approaches to treatments for tuberculosis in countries plagued with the disease. The doctors had the rare chance to treat a pediatric patient with a rare form of drug-resistant TB after the toddler returned from India. The two-year-old child contracted the disease while abroad and was brought to the hospital with signs of tuberculosis. However, when doctors tested the child for TB, the test results came back negative. Despite the results, doctors felt that they had a tuberculosis case on their hands.

It was later discovered that the child suffered from the rare XDR-TB strain that cannot be picked up on common TB tests. Unfortunately, the strain is also extremely hard to treat, as it is resistant to all of the common drugs used to treat TB. Therefore, doctors at John Hopkins were forced to take a more creative approach to the child’s care and ultimately ended up curing the toddler of the disease in three months.

The child is now five years old and healthy. Now the doctors who treated the child are hoping to use the information they obtained during their treatment procedure to help children in third-world countries receive better treatment and diagnosis. A HUB report notes that doctors were fighting not only against a highly drug-resistant disease, but also with a lack of pediatric information for drugs available. It was noted that TB, even regular strains, can go undiagnosed in children due to the fact that children harbor less of the TB bacteria in their system. Therefore, false negatives are common. In addition to problems with diagnosis, the team also dealt with the fact that many of the drugs manufactured to treat TB do not have pediatric-friendly dosages. Therefore, doctors are forced to test the dosages out themselves.

“The doctors also struggled with a lack of fast, reliable diagnostic tools to track the disease and a lack of pediatric-friendly drug formulations.”

The doctors noted that the toddler treated in the United States was a perfect example of false negative TB readings. The doctors say that it highlights the need for a faster and more reliable test. After receiving a proper diagnosis, doctors used a CT scan to obtain real-time tracking of how the tuberculosis was responding to specific treatments. The doctors say this CT scan was vital for a successful treatment and that image scanning devices should be made available in all pediatric clinics.

“Many factors made this a challenging case, including how physicians would monitor on a timely basis whether the drugs had reduced or eliminated the bacteria. The effective use of CT monitoring was first shown in the laboratory, with mice, and low-radiation CT imaging has provided a readily translatable solution for this case.”

Meanwhile, TB has surpassed HIV/AIDS as deadliest infectious disease.

What do you think about the doctors’ findings? Is it practical to have CT scanning equipment in all treatment facilities that deal with pediatric tuberculosis?