Case Study

Late diagnosis of multidrug-resistant tuberculosis in a child at Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa: A case report

Bakani A. Siwele, Ndivhuho A. Makhado, Matodzi T. Mariba
African Journal of Laboratory Medicine | Vol 8, No 1 | a783 | DOI: https://doi.org/10.4102/ajlm.v8i1.783 | © 2019 Bakani A. Siwele, Ndivhuho A. Makhado, Matodzi T. Mariba | This work is licensed under CC Attribution 4.0
Submitted: 02 February 2018 | Published: 29 July 2019

About the author(s)

Bakani A. Siwele, Department of Orthopaedics, Sefako Makgatho Health Science University, Pretoria, South Africa
Ndivhuho A. Makhado, National Health Laboratory Service – Dr George Mukhari Tertiary Laboratory, Department of Medical Microbiology, Pretoria, South Africa; and, Department of Microbiological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa; and, Global Health Institute, University of Antwerp, Wilrijk, Belgium Department of Biomedical Sciences, Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
Matodzi T. Mariba, Department of Orthopaedics, Sefako Makgatho Health Science University, Pretoria, South Africa


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Abstract

Introduction: South Africa has one of the top ten tuberculosis burdens in the world, only lagging behind countries with significantly larger populations. Increased awareness of extrapulmonary tuberculosis, specifically spinal tuberculosis, is necessary, because of the HIV epidemic.

Case presentation: This report describes the case of a 9-year-old male patient who was suspected of having multidrug-resistant (MDR) tuberculosis, based on failure to recover clinically and radiologically after 6 months on first-line anti-tuberculosis treatment. Pus samples were sent to an accredited academic laboratory for histopathology, microscopy, culture, line-probe assay (MTBDRplus assay) and phenotypic MGIT 960 drug susceptibility tests. Second-line MDR tuberculosis treatment was introduced. Clinical, radiological, physical processes and more laboratory tests were conducted to document whether or not there was improvement in the patient.

Management and outcome: After laboratory diagnosis of MDR tuberculosis, the patient was started on MDR tuberculosis treatment. The patient started improving remarkably after the introduction of anti-tuberculosis treatment and rehabilitation, although he also required surgery to stabilise the spine. Neurological improvement was observed in the patient and he fully recovered.

Discussion: Although the diagnosis of spinal MDR tuberculosis may not be achieved easily by culture, the well-known gold standard method of tuberculosis diagnosis, it is of great importance to rapidly initiate an effective anti-tuberculosis treatment of drug-resistant strains to reduce the deformity of the spine.


Keywords

spinal tuberculosis; extrapulmonary tuberculosis; multidrug-resistant tuberculosis; laboratory diagnosis; radiological improvement

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