title: Extensively drug-resistant tuberculosis in children with human immunodeficiency virus in rural South Africa.
abstract: METHODS
  Extensively drug-resistant tuberculosis (XDR-TB) has been documented worldwide, but reports of XDR-TB in children are extremely limited.
  
  
  OBJECTIVE
  To report the characteristics of pediatric XDR-TB patients in rural South Africa.
  
  
  METHODS
  We retrospectively reviewed children with sputum culture-confirmed XDR-TB from Tugela Ferry, South Africa, from January 2006 to December 2007. Demographic, clinical and microbiologic data were abstracted from medical records.
  
  
  RESULTS
  Four children aged 6-8 years with XDR-TB were reviewed. Two had previous histories of TB. All were human immunodeficiency virus (HIV) infected orphans; three received highly active antiretroviral therapy (HAART) before XDR-TB diagnosis. All had clinical and radiographic improvement and sputum culture conversion while on standardized XDR-TB treatment and HAART. Two tolerated concomitant XDR-TB and HIV treatment well. Two experienced neuropsychiatric side effects related to cycloserine. All have survived >24 months and all were cured. Prior to XDR-TB diagnosis, the children had resided in the hospital's pediatric ward for a median of 8 months (range 5-17), including a 3-month overlapping period.
  
  
  CONCLUSIONS
  XDR-TB is a microbiologic diagnosis that, even with HIV co-infection, can be successfully identified. Concurrent XDR-TB and HIV therapy is feasible and effective in children, although more research is needed into potential overlapping toxicities. Nosocomial transmission is suggested, calling for infection control policies in pediatric wards.
authors.affiliation: Tugela Ferry Care and Research Collaboration, Tugela Ferry, KwaZulu-Natal, South Africa.
authors.forename: T A
authors.initials: TA
authors.lastname: Thomas
authors.forename: S V
authors.initials: SV
authors.lastname: Shenoi
authors.forename: S K
authors.initials: SK
authors.lastname: Heysell
authors.forename: F J
authors.initials: FJ
authors.lastname: Eksteen
authors.forename: V B
authors.initials: VB
authors.lastname: Sunkari
authors.forename: N R
authors.initials: NR
authors.lastname: Gandhi
authors.forename: G
authors.initials: G
authors.lastname: Friedland
authors.forename: N S
authors.initials: NS
authors.lastname: Shah
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D054908:Extensively Drug-Resistant Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D013902:Radiography, Thoracic; D012074:Remission Induction; D012189:Retrospective Studies; D012424:Rural Population; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents