Drug Resistant Tuberculosis in Special Situations
- Pp. 76-83 (8)Rafael Laniado-Laborín
There are three special situations in drug resistant tuberculosis that merit a more detail description: HIV co-infection, pregnancy and drug resistant TB in children. HIV co-infection: The risk of reactivation of latent tuberculosis infection is 50-100 times higher for subject living with HIV and up to 170 times higher for those with AIDS. Every patient diagnosed with TB must be tested for HIV infection and vice versa. The WHO recommends that ARV treatment in patients recently diagnosed as co-infected with HIV and tuberculosis should start within 8 weeks from the start on antituberculosis drugs. </p><p> Pregnancy: The best way to deal with MDR-TB during pregnancy is to prevent it. All females of child-bearing age being treated for MDR-TB should be encouraged to adopt an effective contraceptive method or even a combination of them. Most of the drugs used to treat MDR-TB are classified as unsafe during pregnancy or their safety is unknown. </p><p> Pediatric tuberculosis: Unlike the adults, most MDR-TB pediatric cases are the result of infection with an already resistant strain, frequently from contact with a household adult. Children with signs and symptoms compatible with active tuberculosis and risk factors for MDR-TB should be started on MDR-TB treatment even if the diagnosis has not been confirmed bacteriologically.