Abstract
IntroductionSouth Africa has one of the top ten tuberculosis burdens in the world, only lagging behind countries with significantly larger populations. Increased awareness of extrapulmonary tuberculosis, specifically spinal tuberculosis, is necessary, because of the HIV epidemic.Case presentationThis report describes the case of a 9-year-old male patient who was suspected of having multidrug-resistant (MDR) tuberculosis, based on failure to recover clinically and radiologically after 6 months on first-line anti-tuberculosis treatment. Pus samples were sent to an accredited academic laboratory for histopathology, microscopy, culture, line-probe assay (MTBDRplus assay) and phenotypic MGIT 960 drug susceptibility tests. Second-line MDR tuberculosis treatment was introduced. Clinical, radiological, physical processes and more laboratory tests were conducted to document whether or not there was improvement in the patient.Management and outcomeAfter laboratory diagnosis of MDR tuberculosis, the patient was started on MDR tuberculosis treatment. The patient started improving remarkably after the introduction of anti-tuberculosis treatment and rehabilitation, although he also required surgery to stabilise the spine. Neurological improvement was observed in the patient and he fully recovered.DiscussionAlthough the diagnosis of spinal MDR tuberculosis may not be achieved easily by culture, the well-known gold standard method of tuberculosis diagnosis, it is of great importance to rapidly initiate an effective anti-tuberculosis treatment of drug-resistant strains to reduce the deformity of the spine.
Highlights
South Africa has one of the top ten tuberculosis burdens in the world, only lagging behind countries with significantly larger populations
Is South Africa one of the top 10 countries in the world for prevalence of tuberculosis, but it has the highest number of patients with DR tuberculosis in the world
It has been proven that half of extrapulmonary tuberculosis cases have been previously reported, and delayed diagnosis may further enhance the risk of transmission of tuberculosis via contacts with more people, as well as compromising healthcare workers.[10]
Summary
Tuberculosis is the most common infectious disease and is responsible for a high rate of morbidity and mortality when not properly managed.[1] Co-infection with HIV and tuberculosis, and the increasing emergence of drug-resistant (DR) strains of tuberculosis, especially multidrugresistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis, present a major threat to effective tuberculosis control.[2,3] is South Africa one of the top 10 countries in the world for prevalence of tuberculosis, but it has the highest number of patients with DR tuberculosis in the world. Factors associated with clinical aspects, radiology and late diagnosis of MDR tuberculosis of the spine and its clinical outcome are reported
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