Infection and drug resistance
Two Case Reports of Drug-Resistant Tuberculous Pleurisy in Children: Thoracoscopic Pleural Biopsy and PCR-Based Drug-Resistance Testing
Par Huang Y, Guo Q, Li Y et 3 autres.
Contenu en anglais
Résumé
Background
Drug-resistant tuberculous pleurisy is difficult to diagnose in children because pleural fluid is paucibacillary, culture is slow and frequently negative, and Xpert detects only rifampicin resistance.
Case presentation
We report two children in whom thoracoscopic pleural biopsy combined with PCR-high-resolution melting (HRM) drug-resistance testing identified drug-resistant tuberculosis. Case 1, an 8-year-old girl with tuberculous pleurisy, showed persistent pleural thickening and a new mass after two months of standard first-line therapy; pleural tissue PCR detected rpoB and inhA mutations, confirming multidrug-resistant tuberculosis (MDR-TB), and she responded to an all-oralbedaquiline- and delamanid-containing regimen. Case 2, a 9-year-old boy with loculated tuberculous pleurisy and negative cultures, had an rpoB mutation confirming rifampicin-monoresistant tuberculosis; he recovered with a rifampicin-sparing regimen and remained relapse-free at one year.