title: Extensively drug-resistant tuberculosis in a young child after travel to India.
abstract: Extensively drug-resistant (XDR) tuberculosis is becoming increasingly prevalent worldwide, but little is known about XDR tuberculosis in young children. In this Grand Round we describe a 2-year-old child from the USA who developed pneumonia after a 3 month visit to India. Symptoms resolved with empirical first-line tuberculosis treatment; however, a XDR strain of Mycobacterium tuberculosis grew in culture. In the absence of clinical or microbiological markers, low-radiation exposure pulmonary CT imaging was used to monitor treatment response, and guide an individualised drug regimen. Management was complicated by delays in diagnosis, uncertainties about drug selection, and a scarcity of child-friendly formulations. Treatment has been successful so far, and the child is in remission. This report of XDR tuberculosis in a young child in the USA highlights the risks of acquiring drug-resistant tuberculosis overseas, and the unique challenges in management of tuberculosis in this susceptible population.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Salazar-Austin
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Ordonez
authors.affiliation: Department of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Alice Jenh
authors.initials: AJ
authors.lastname: Hsu
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Benson
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mahadevappa
authors.initials: M
authors.lastname: Mahesh
authors.affiliation: Howard County Health Department, Columbia, MD, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Menachery
authors.affiliation: Maryland Department of Health and Mental Hygiene, Laboratories Administration, Baltimore, MD, USA.
authors.forename: Jafar H
authors.initials: JH
authors.lastname: Razeq
authors.affiliation: National Jewish Health Mycobacteriology Laboratory, Denver, CO, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Salfinger
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Starke
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Parrish
authors.affiliation: Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Nuermberger
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: sjain5@jhmi.edu.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Jain
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002675:Child, Preschool; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007194:India; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity / Q000502:physiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D011859:Radiography; D014195:Travel; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D014481:United States
chemical_list: D000995:Antitubercular Agents