Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Multidrug-Resistant Tuberculosis Presenting as Miliary Tuberculosis without Immune Suppression: A Case Diagnosed Rapidly with the Genotypic Line Probe Assay Method

  • Ko, Yousang (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Ho Young (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Young Seok (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Song, Junwhi (Department of Pulmonology, Samsung Changwon Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Mi-Yeong (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Hyun-Kyung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Shin, Jeong Hwan (Department Laboratory Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Choi, Seok Jin (Department Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Young-Min (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine)
  • Received : 2013.10.18
  • Accepted : 2014.01.03
  • Published : 2014.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Miliary tuberculosis (TB) is a rare extrapulmonary form of TB, and there have been only two reports of miliary TB associated with infection with multidrug-resistant (MDR)-TB pathogen in an immunocompetent host. A 32-year-old woman was referred to our hospital because of abnormal findings on chest X-ray. The patient was diagnosed with MDR-TB by a line probe assay and was administered proper antituberculous drugs. After eight weeks, a solid-media drug sensitivity test revealed that the pathogen was resistant to ethambutol and streptomycin in addition to isoniazid and rifampicin. The patient was then treated with effective antituberculous drugs without delay after diagnosis of MDR-TB. To the best of our knowledge, this is the first case of miliary TB caused by MDR-TB pathogen in Korea.

Keywords

References

  1. Gandhi NR, Nunn P, Dheda K, Schaaf HS, Zignol M, van Soolingen D, et al. Multidrug-resistant and extensively drugresistant tuberculosis: a threat to global control of tuberculosis. Lancet 2010;375:1830-43. https://doi.org/10.1016/S0140-6736(10)60410-2
  2. Falzon D, Jaramillo E, Schunemann HJ, Arentz M, Bauer M, Bayona J, et al. WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update. Eur Respir J 2011;38:516-28. https://doi.org/10.1183/09031936.00073611
  3. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. WHO/HTM/TB/2006.361. Geneva: WHO; 2006.
  4. Centers for Disease Control and Prevention. Reported tuberculosis in the United States, 2010. Atlanta: Centers for Disease Control and Prevention; 2011.
  5. Daikos GL, Uttamchandani RB, Tuda C, Fischl MA, Miller N, Cleary T, et al. Disseminated miliary tuberculosis of the skin in patients with AIDS: report of four cases. Clin Infect Dis 1998;27:205-8. https://doi.org/10.1086/514608
  6. Hill AR, Premkumar S, Brustein S, Vaidya K, Powell S, Li PW, et al. Disseminated tuberculosis in the acquired immunodeficiency syndrome era. Am Rev Respir Dis 1991;144:1164-70. https://doi.org/10.1164/ajrccm/144.5.1164
  7. Shah A, Panjabi C, Maurya V, Khanna P. Multidrug resistant miliary tuberculosis and Pott's disease in an immunocompetent patient. Saudi Med J 2004;25:1468-70.
  8. Sasse J, Teichmann D. Disseminated multiorgan MDRTB resistant to virtually all first-line drugs. Eur Respir Rev 2009;18:291-4. https://doi.org/10.1183/09059180.00002109
  9. Kim SY, Kim HJ, Kim CK, Yoon HR, Bae HG, Lee SH, et al. The recent status of multidrug- and extensively drug-resistant tuberculosis in Korea. Tuberc Respir Dis 2010;68:146-54. https://doi.org/10.4046/trd.2010.68.3.146
  10. Caminero JA. Multidrug-resistant tuberculosis: epidemiology, risk factors and case finding. Int J Tuberc Lung Dis 2010;14:382-90.
  11. Kim JH, Langston AA, Gallis HA. Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis, and outcome. Rev Infect Dis 1990;12:583-90. https://doi.org/10.1093/clinids/12.4.583
  12. Ray S, Talukdar A, Kundu S, Khanra D, Sonthalia N. Diagnosis and management of miliary tuberculosis: current state and future perspectives. Ther Clin Risk Manag 2013;9:9-26.
  13. Ahmad S, Mokaddas E. Recent advances in the diagnosis and treatment of multidrug-resistant tuberculosis. Respir Med 2009;103:1777-90. https://doi.org/10.1016/j.rmed.2009.07.010
  14. Morgan M, Kalantri S, Flores L, Pai M. A commercial line probe assay for the rapid detection of rifampicin resistance in Mycobacterium tuberculosis: a systematic review and metaanalysis. BMC Infect Dis 2005;5:62. https://doi.org/10.1186/1471-2334-5-62
  15. Bwanga F, Hoffner S, Haile M, Joloba ML. Direct susceptibility testing for multi drug resistant tuberculosis: a meta-analysis. BMC Infect Dis 2009;9:67. https://doi.org/10.1186/1471-2334-9-67

Cited by

  1. Diagnostic usefulness of the GenoType MTBDRplusassay for detecting drug-resistant tuberculosis using AFB smear-negative specimens with positive TB-PCR result vol.48, pp.5, 2016, https://doi.org/10.3109/23744235.2015.1122831
  2. An Unusual Case of Multidrug Resistant Miliary Tuberculosis vol.11, pp.4, 2014, https://doi.org/10.5812/archcid.37805
  3. First Use of Bedaquiline in Democratic Republic of Congo: Two Case Series of Pre Extensively Drug Resistant Tuberculosis vol.6, pp.2, 2014, https://doi.org/10.4236/jtr.2018.62012