Akademik Veri Yönetim Sistemi
Cocuk Enfeksiyon Dergisi, cilt.18, sa.2, ss.114-118, 2024 (ESCI)
Multidrug-resistant tuberculosis (MDR-TB) is resistance to both isoniazid and rifampicin. In treatment, five sensitive drugs should be given, one parenteral and one quinolone. Five cases with family contact are presented. A girl presented with bleeding from the mouth and nose and petechiae on the feet. There were hypercarbia, anemia, severe thrombocytopenia, increased CRP and D-dimer. Myeloid leukocyte and megakaryocytic series were increased and erythrocyte series were decreased in bone marrow. Chest X-ray was consistent with necrotizing pneumonia. In the foreground, immune thrombocytopenic purpura (ITP) was accepted as the diagnosis. She did not benefit from intravenous immunoglobulin (IVIG) treatment. ITP was excluded because there was no platelet destruction after platelet replacement. When history was deepened, it was learned that the mother had MDR-TB a year ago. Her calories were increased. The mother’s other three children and niece living in the same house were also screened. All of the children were girls, and their ages, symptoms, findings, treatment and side effects are given in the table. Audiometric follow-up, visual examinations, electrocardiography, blood sugar level, liver, kidney, and thyroid functions were monitored regularly. Linezolid-induced neutropenia was observed in two patients and the linezolid dose was reduced by 30%. After this change, neutropenia resolved in one patient, and treatment including linezolid was continued. Since there was no improvement in the other patient, linezolid was discontinued and para-amino salicylic acid treatment was started, and then neutropenia resolved. Management of MDR-TB in pediatric patients is a process that requires patience and dedication. The use of second-line drugs in children is necessary to treat life-threatening MDR-TB, but careful monitoring is required to recognize dose- and duration-dependent drug adverse events quickly.