In Practice

When to start treatment? Dilemma illustrated by a paediatric case of extensively drug-resistant tuberculosis of the central nervous system

R M S Gigi, H L Rieder, N Padayatchi


An HIV-positive mother infected her daughter with extensively drug-resistant Mycobacterium tuberculosis. Despite adhering to the then current guidelines for prevention, the infant was diagnosed with extensively drug-resistant pulmonary tuberculosis at the age of 4 months and developed tuberculous meningitis. After a short delay, appropriate treatment was initiated, followed by an inhospital stay at a specialised hospital. The infant became generally well, but had delayed neurological development. Secondary hydrocephalus due to tuberculous meningitis required a ventriculoperitoneal shunt. After 2 years of microbiologically and clinically effective tuberculosis treatment and several shunt complications, the HIV-negative child died at the age of 28 months ‒ with radiological signs of a shunt infection. The reason for the fatal outcome was probably related to inadequate risk reduction of airborne mother-to-child transmission, inappropriate chemoprophylaxis and delayed initiation of adequate treatment.

Authors' affiliations

R M S Gigi, Faculty of Medicine, University of Zurich, Switzerland

H L Rieder, Biostatistics and Prevention Institute, University of Zurich, Switzerland

N Padayatchi, South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa

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Paediatric tuberculosis; Central nervous system; Meningeal; Extensive drug resistance; South Africa

Cite this article

South African Medical Journal 2020;110(9):846-849. DOI:10.7196/SAMJ.2020.v110i9.14567

Article History

Date submitted: 2020-08-31
Date published: 2020-08-31

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