Resistant Mycobacterium bovis Bacillus Calmette-Guérin disease: implications for management of Bacillus Calmette-Guérin Disease in human immunodeficiency virus-infected children.
Guidelines for the diagnosis and management of Bacillus Calmette-Guérin (BCG) disease in children are lacking, and there are limited data on drug resistance of Mycobacterium bovis BCG. A 6-month-old HIV-infected infant presented with right axillary adenitis ipsilateral to the site of BCG immunization. M. tuberculosis complex was cultured from axillary lymph nodes and gastric aspirates, and M. bovis BCG was isolated. Susceptibility testing before initiation of therapy demonstrated inherent resistance to isoniazid. The organism acquired rifampin resistance during therapy. This was confirmed by the presence of a mutation in codon 531 (Ser531Tyr) of the rpoB gene. Treatment guidelines for BCG disease with consideration of inherent and possible acquired drug resistance should be established in settings with high rates of vertical HIV transmission and routine BCG vaccination.
Hesseling
Anneke C
AC
Center for Tuberculosis Research and Education, Department of Pediatrics and Child Health, Tygerberg Children's Hospital, Tygerberg, South Africa. ach2105@columbia.edu
Schaaf
Hendrik S
HS
Victor
Thomas
T
Beyers
Nulda
N
Marais
Ben J
BJ
Cotton
Mark F
MF
Wiid
Ian
I
Gie
Robert P
RP
van Helden
Paul
P
Warren
Robin M
RM
D000818:Animals; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D001500:BCG Vaccine / Q000009:adverse effects; D002417:Cattle; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D024881:Drug Resistance, Bacterial; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D009154:Mutation; D009163:Mycobacterium bovis / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology* / Q000517:prevention & control
D000995:Antitubercular Agents; D001500:BCG Vaccine; D012321:DNA-Directed RNA Polymerases; C105078:RNA polymerase beta subunit; D007538:Isoniazid; D012293:Rifampin