Hopkins Physicians Successfully Treat 2-Year-Old with Highly Virulent, Extensively Drug-Resistant Tuberculosis (XDR-TB); Case Highlights Serious Challenges of Monitoring and Treating Pediatric TB

Johns Hopkins Children's Center medical specialists report they have successfully treated and put in remission a 2-year-old girl, now age 5, with a highly virulent form of tuberculosis known as extensively drug-resistant TB (XDR TB). The case, researchers say, provides the first detailed account of a young child in the United States diagnosed and treated for XDR TB. The mycobacterium pathogen’s resistance to most known TB drugs render it particularly challenging to treat in anyone, but even more so in children, the Johns Hopkins team says, with only a handful of cases of children younger than 5 described in the medical literature worldwide. Despite the successful outcome, the Johns Hopkins experts say the child's case underscores the shape-shifting nature of a mycobacterium increasingly resistant to drugs, and the serious challenges of monitoring and treating pediatric TB. "We are thrilled that our patient is doing so well," says Johns Hopkins Children's Center pediatrician and TB expert Sanjay Jain, M.D. "But at the same time, this is a wake-up call to the realities of TB." In an account of the case, published online on November 16, 2015 in The Lancet Infectious Diseases, the Johns Hopkins team describes the hurdles they faced throughout the child's treatment along with several "pearls" of clinical wisdom gleaned from it. The article is titled “Extensively Drug-Resistant Tuberculosis in a Young Child After Travel to India.” Note that the article abstract (link below) includes a video related to this report. Mycobacterium tuberculosis, the mycobacterium responsible for TB, is estimated to cause almost 10 million new cases of TB disease worldwide each year, with strains impervious to drug therapies rapidly spreading.
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