Long term follow-up of multidrug resistant tuberculosis in a pubertal child

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Andri Kurnia Wahyudhi
Retno Asih Setyoningrum
Ahmad Suryawan


Increasing awareness of the rising global rates of multidrug-resistant tuberculosis (MDR-TB) has led to a concerted international effort to confront this disease. Nonetheless, despite cure rates >80% in some programs, MDR-TB patients tend to have chronic disease and require prolonged therapy.1-3 Little is known about the long-term results and follow-up of patients with MDR-TB, include the recurrence rate and chronic disability in patients who have recovered from TB.4

There are many side effects and adverse reactions to drugs can occur during MDR-TB treatment. These could be physical and or psychological, as well as reversible or irreversible. Treatment of MDR-TB requires a combination regimen, consists of second and third-line anti-tuberculosis drugs which more toxic than first-line drugs. Additionally, MDR-TB treatment requires a long duration of treatment (18-24 months) and causes discomfort in the patient.5 In a cohort of 60 patients treated for MDR-TB, the most common side effects included gastritis (100%), dermatological disorders (43%), and peripheral neuropathy (16.7).6 While in a cohort of 75 patients, the incidence of depression, anxiety, and psychosis for MDR-TB treatments was 13.3%, 12.0%, and 12.0%, respectively.7

Aggressive and effective management are needed so the patient can tolerate the treatment and remain adhere the treatment.8 Long-term follow-up is required for the rehabilitation of disorders due to psychosocial sequelae.  As such, psychosocial support can be benefit pediatric MDR-TB patients.  

Here, we present a case report on a two-year follow-up of a pubertal child with MDR-TB,  focusing on medical aspects and her development.

Article Details

How to Cite
Wahyudhi A, Setyoningrum R, Suryawan A. Long term follow-up of multidrug resistant tuberculosis in a pubertal child. PI [Internet]. 30Aug.2018 [cited 26May2019];58(4):198-04. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1163
Case Report
Received 2017-01-18
Accepted 2018-08-10
Published 2018-08-30


1. Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, et al. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med. 2003;348:119–28.
2. Tahaoglu K, Torun T, Sevim T, Atac G, Kir A, Karasulu L, et al. The treatment of multidrug-resistant tuberculosis in Turkey. N Engl J Med. 2001;345:170–4.
3. Leimane V, Riekstina V, Holtz T, Zarovska E, Skripconoka V, Thorpe L, et al. Clinical outcome of individualized treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Lancet. 2005;365:318–26.
4. Ando M, Mori A, Esaki H, Shiraki T, Uemura H, Okazawa M, et al. The effect of pulmonary rehabilitation in patients with post-tuberculosis lung disorder. Chest. 2003;123:1988–95.
5. Acha J, Sweetland A, Guerra D, Chalco K, Castillo H, Palacios E. Psychosocial support groups for patients with multidrug-resistant tuberculosis: five years of experience. Glob Public Health. 2007;2:404-17.
6. Furin JJ, Mitnick CD, Shin SS, Bayona J, Becerra MC, Singler JM, et al. Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2001;5:648-55.
7. Vega P, Sweetland A, Acha J, Castillo H, Guerra D, Smith Fawzi MC, et al. Psychiatric issues in the management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2004;8:749-59.
8. Arbex MA, Varella MCL, Siqueira HR, Mello FA. Antituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 2: second-line drugs. J Bras Pneumol. 2010;36:641-56.
9. Hendarto A and Sjarif DR. Antropometri Anak dan Remaja. In: Sjarif DR, Lestari ED, Mexitalia M, and Nasar SS, editor. Buku Ajar Nutrisi Pediatrik dan Penyakit Metabolik. Balai Penerbit IDAI, 2011:p25-37.
10. Nellhaus G. Head circumference from birthto eighteen years: practical composite international and interracial. Pediatrics. 1968;41(1):106-14.
11. Murphy M, Bergmann P, Chiang C, Sturner R, Howard B, Abel MR et al. The PSC-17: subscale scores, reliability, and factor structure in a new national sample. Pediatrics. 2016;138(3):e20160038
12. Dheda K, Gumbo T, Gandhi NR, Murray M, Theron G, Udwadia Z, et al. Global control of tuberculosis: from extensively drug-resistant to untreatable tuberculosis. Lancet Respir Med. 2014;2(4):321-38.
13. Ford CB, Shah RR, Maeda MK, Gagneux S, Murray MB, Cohen T, et al. Mycobacterium tuberculosis mutation rate estimates from different lineages predict substantial differences in the emergence of drug-resistant tuberculosis. Nat Genet 2013; 45: 784–90.
14. Chigutsa E, Visser ME, Swart EC, Denti P, Pushpakom S, Egan D, et al. The SLCO1B1 rs4149032 polymorphism is highly prevalent in South Africans and isassociated with reduced rifampin concentrations: dosingimplications. Antimicrob Agents Chemother 2011; 55: 4122–27.
15. Biadglegne F, Sack U, and Rodloff AC. Multidrug-resistant tuberculosis in Ethiopia: efforts to expand diagnostic services, treatment and care. Antimicrob Resist Infect Control. 2014;3:31-40.
16. Dheda K, Gumbo T, Gandhi NR, Murray M, Theron G, Udwadia Z, et al. Global control of tuberculosis: from extensively drug-resistant to untreatable tuberculosis. Lancet Respir Med. 2014;2:321-38.
17. Byrd RP Jr, Mehta JB, and Roy TM. Malnutrition and pulmonary tuberculosis. Clin Infect Dis. 2002;35:634-5.
18. Direktorat Jendral Penanggulangan Penyakit Dan Penyehatan Lingkungan, Kementrian Kesehatan Republik Indonesia. Petunjuk teknis manajemen TB anak. Jakarta: Kemenkes RI; 2013. p. 44-8.
19. Direktorat Jendral penanggulangan penyakit dan penyehatan lingkungan, Kementrian Kesehatan Republik Indonesia. Petunjuk teknis manajemen terpadu pengendalian tuberkulosis resistant obat. Jakarta: Kemenkes RI; 2013. p. 1-69.
20. Prasad R, Verma SK, Sahai S, Kumar S, and Jain A. Efficacy and safety of Kanamycin, Ethionamide, PAS and Cycloserine in multi-drug resistant pulmonary tuberculosis patients. Indian J Chest Dis Allied Sci. 2006; 48:183-186.
21. Arbex MA, Varella MCL, Siqueira HR, and Mello FAF. Antituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 1: second-line drugs. J Bras Pneumol. 2010;36:626-40.
22. Pasipanodya JG, Miller TL, Vecino M, Munguia G, Garmon R, Bae S, et al. Pulmonary impairment after tuberculosis. Chest. 2007;131:1817-24.
23. Lee EJ, Lee SY, In KH, Yoo SH, Choi EJ, Oh YW, et al. Routine pulmonary function test can estimate the extent of tuberculous destroyed lung. Scientific World Journal. 2012;2012:835031.
24. Ryu YJ, Lee JH, Chun EM, Chang JH, and Shim SS. Clinical outcomes and prognostic factors in patients with tuberculous destroyed lung. Int J Tuberc Lung Dis. 2011;15:246–50.
25. Eren S, Eren MN, and Balcı AE. Pneumonectomy in children for destroyed lung and the long-term consequences. J Thorac Cardiovasc Surg. 2003;126:574-81.
26. Ahmed AEH, Ibrahim AS, and Elshafie SM. Pulmonary hypertension in patients with treated pulmonary tuberculosis: analysis of 14 consecutive cases. Clin Med Insights Circ Respir Pulm Med. 2011;5:1-5.
27. Bhattacharyya P, Saha D, Bhattacherjee PD, Das SK, Bhattacharyya PP, Dey R. Tuberculosis associated pulmonary hypertension: the revelation of a clinical observation. Lung India. 2016;33:135-9.
28. Hammerstingl C, Schueler R, Bors L, Momcilovic D, Pabst S, Nickenig G, et al. Diagnostic value of echocardiography in the diagnosis of pulmonary hypertension. PLoS One. 2012;7:e38519.
29. Ghofrani HA, Wiedemann R, Rose F, Schermuly RT, Olschewski H, Weissmann N, et al. Sildenafil for treatment of lung fibrosis and pulmonary hypertension: a randomised controlled trial. Lancet. 2002;360:895–900.
30. Seeger W, Adir Y, Barberà JA, Champion H, Coghlan JG, Cottin V, et al. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013;62:109–16.
31. Society on Spinal Orthopaedic and Rehabilitation Treatment. Guideline Committee, Weiss HR, Negrini S, Rigo M, Kotwicki T, Hawes MC, et al. Indications for conservative management of scoliosis (guidelines). Scoliosis. 2006;1:5.
32. Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, et al. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012;7:3.
33. Peltzer K, Naidoo P, Matseke G, Louw J, McHunu G, Tutshana B. Prevalence of psychological distress and associated factors in tuberculosis patients in public primary care clinics in South Africa. BMC Psychiatry. 2012;12:89.
34. Cassileth BR, Lusk EJ, Strouse TB, Miller DS, Brown LL, Cross PA, et al. Psychosocial status in chronic illness: a comparative analysis of six diagnostic groups. N Eng J Med. 1984;311:506–11.
35. Kiecolt-Glaser JK, Glaser R. Depression and immune function: central pathways to morbidity and mortality. J Psychosom Res. 2002;53:873–6.
36. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996;276:293-9.
37. Ahmad N, Javaid A, Syed Sulaiman SA, Basit A, Afridi AK, Jaber AA, et al. Effects of multidrug resistant tuberculosis treatment on patients’ health related quality of life: results from follow up study. PLoS One. 2016;11:e0159560.