Chest Infections |

Primary Extensively Drug Resistant Tuberculosis (XDRTB) - Successful Treatment With Linezolid FREE TO VIEW

Sukhesh Rao, MD
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Father Muller Medical College, Mangalore, India

Chest. 2014;145(3_MeetingAbstracts):97A. doi:10.1378/chest.1832637
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SESSION TITLE: Tuberculosis Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

PURPOSE: The aim of this presentation is to highlight the rarity of the case and use of a newer drug in successfully treating the patient.

METHODS: 32 year old male presented with symptoms of cough,fever and loss of appetite for past 2 months. Symptomatic treatment with antibiotics and anti inflammatory drugs prior to presentation did not provide relief. Investigations confirmed him to be a case of smear positive pulmonary tuberculosis. Since he was from a high risk area, sputum was sent for AFB culture sensitivity prior to starting treatment.Results of other investigations were unremarkable.

RESULTS: Patient was put on standard anti tubercular treatment(ATT) as per protocol. Astonishingly his sensitivity report turned out to be a case of XDR TB. Since there was no past history of Tuberculosis or inadvertent exposure to Antituberculosis drugs, he was diagnosed as a case of Primary XDRTB. He was put on retreatment regimen consisting of Kanamycin, Paraaminosalicylic acid, Cycloserine, Isoniazid and Linezolid for initial six months(sputum conversion), following which kanamycin was withdrawn and remaining drugs continued for further 15 months.During the treatment period he was assesed by sputum smear microscopy and Chest radiogram at monthly intervals till smear conversion. Later he was assesed once in 2 months.Sputum culture was examined at the time of smear conversion(6 months), 1 year and at the end of treatment. He was smear and culture negative at the end of treatment and remained so for 1 year,following which he was lost for follow up.

CONCLUSIONS: Linezolid is an effective and safe alternative as a companion drug even in cases of XDRTB.

CLINICAL IMPLICATIONS: In specific clinical situations, possibility of MDR(Multidrug resistant)TB and XDRTB should be considered even in absence of past history of exposure to ATT. Linezolid can and should be tried in such cases specially in the absence of better and safer alternatives.

DISCLOSURE: The following authors have nothing to disclose: Sukhesh Rao

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