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Case of the Month - April 2016

Case of the Month – April 2016

Infants can get extensively drug-resistant tuberculosis (XDR-TB)

H. Simon Schaaf and Helena Rabie
Department of Paediatrics and Child Health, Tygerberg Academic Hospital and Stellenbosch University

An 11-month-old boy, weight 9.6 kg, presented to the emergency room with a short history of fever and two weeks of cough. He had no failure to thrive or weight loss. Social history revealed that the family rented a room from a woman who had tuberculosis (TB) but was not on therapy. The child was not on any antituberculosis medication or preventive therapy.

His clinical examination was unremarkable accept for a unilateral wheeze suggestive of large airway compression. The chest radiographs showed hilar lymphadenopathy, right middle lobe opacification and left main bronchus compression. The infant was not HIV exposed and his own status was negative. Mantoux tuberculin skin test was not performed because it was not available.

Figure 1. a) Anteroposterior and b) lateral chest radiographs showing hilar nodes, right middle lobe opacification and left main bronchus narrowing
Question 1: How would you further manage this child regarding the diagnosis of tuberculosis?

Continue to Answer 1