Diagnosis and Treatment of Drug-Resistant Tuberculosis

Birce SUNMANa , Nagehan EMİRALİOĞLUa , Elmas Ebru YALÇINa

aHacettepe University Faculty of Medicine, Department of Pediatric Chest Diseases, Ankara, Türkiye

ABSTRACT
Globally, an estimated annual incidence of 25,000-30,000 cases of drug-resistant tuberculosis (DR-TB) in children is observed, although a significant proportion of these cases remain undiagnosed and inadequately treated. DR-TB referring to any resistance to tuberculosis drugs is caused by genetic mutations of Mycobacterium tuberculosis bacilli and is a consequence of an inadequate or poorly administered treatment regimen, and delayed diagnosis. Most of the children have paucibacillary disease that could not be bacteriologically confirmed, therefore, clinical suspicion of DR-TB, taking a detailed history of source case with DR-TB and previous tuberculosis treatment is important to make a diagnosis and initiate treatment. Treatment for DR-TB is rapidly changing with the addition of new drugs (bedaquiline and delamanid) and the use of older drugs (linezolid, clofazimine) that have been repurposed. In addition, the introduction of shorter and injectable-free, all-oral DR-TB treatment regimens represent shining star of the future. Diagnosing children with DR-TB and initiate the correct treatment regimens should be our main focus.
Keywords: Children; multidrug resistant; pediatric; treatment; tuberculosis

Referanslar

  1. Song WM, Li YF, Liu YX, Liu Y, Yu CB, Liu JY, et al. Drug-Resistant Tuberculosis Among Children: A Systematic Review and Meta-Analysis. Front Public Health. 2021;9:721817. [Crossref]  [PubMed]  [PMC]
  2. World Health Organization. Global Tuberculosis Report. Geneva: World Health Organization; 2022.
  3. Poorana Ganga Devi NP, Swaminathan S. Drug-resistant tuberculosis: pediatric guidelines. Curr Infect Dis Rep. 2013;15(5):356-63. [Crossref]  [PubMed]
  4. Howell P, Achar J, Huang GKL, Mariandyshev A, Schaaf HS, Garcia-Prats AJ. Treatment of Rifampicin-Resistant Tuberculosis Disease and Infection in Children: Key Updates, Challenges and Opportunities. Pathogens. 2022;11(4). [Crossref]  [PubMed]  [PMC]
  5. Dheda K, Chang KC, Guglielmetti L, Furin J, Schaaf HS, Chesov D, et al. Clinical management of adults and children with multidrug-resistant and extensively drug-resistant tuberculosis. Clin Microbiol Infect. 2017;23(3):131-40. [Crossref]  [PubMed]
  6. Zhu H, Zhou X, Zhuang Z, Li L, Bi J, Mi K. Advances of new drugs bedaquiline and delamanid in the treatment of multi-drug resistant tuberculosis in children. Front Cell Infect Microbiol. 2023;13:1183597. [Crossref]  [PubMed]  [PMC]
  7. Management of Drug-Resistant Tuberculosis in Children: A Field Guide. The Sentinel Project for Pediatric Drug-Resistant Tuberculosis. 4th ed. Boston, USA: 2018.
  8. Seddon JA, Perez-Velez CM, Schaaf HS, Furin JJ, Marais BJ, Tebruegge M, et al. Consensus Statement on Research Definitions for Drug-Resistant Tuberculosis in Children. J Pediatric Infect Dis Soc. 2013;2(2):100-9. [Crossref]  [PubMed]  [PMC]
  9. Marais BJ, Gie RP, Obihara CC, Hesseling AC, Schaaf HS, Beyers N. Well defined symptoms are of value in the diagnosis of childhood pulmonary tuberculosis. Arch Dis Child. 2005;90(11):1162-5. [Crossref]  [PubMed]  [PMC]
  10. Seddon JA, Johnson S, Palmer M, van der Zalm MM, Lopez-Varela E, Hughes J, et al. Multidrug-resistant tuberculosis in children and adolescents: current strategies for prevention and treatment. Expert Rev Respir Med. 2021;15(2):221-37. [Crossref]  [PubMed]
  11. Multidrug-resistant tuberculosis in children and adolescents in the WHO European Region, Expert opinion. Copenhagen: WHO Regional Office for Europe; 2019.
  12. Koser CU, Cirillo DM, Miotto P. How To Optimally Combine Genotypic and Phenotypic Drug Susceptibility Testing Methods for Pyrazinamide. Antimicrob Agents Chemother. 2020;64(9). [Crossref]  [PubMed]  [PMC]
  13. Yusoof KA, Garcia JI, Schami A, Garcia-Vilanova A, Kelley HV, Wang SH, et al. Tuberculosis Phenotypic and Genotypic Drug Susceptibility Testing and Immunodiagnostics: A Review. Front Immunol. 2022;13:870768. [Crossref]  [PubMed]  [PMC]
  14. WHO operational handbook on tuberculosis. Module 3: diagnosis - rapid diagnostics for tuberculosis detention, 2021 update. Geneva: World Health Organization; 2021.
  15. Seddon JA, Schaaf HS. Drug-resistant tuberculosis and advances in the treatment of childhood tuberculosis. Pneumonia (Nathan). 2016;8:20. [Crossref]  [PubMed]  [PMC]
  16. WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022.
  17. Rapid communication: key changes to the treatment of drug-resistant tuberculosis. Geneva: World Health Organization; 2022.