P27 A challenging case of MDR TB infection following a holiday in India
Abstract
Abstract Background TB is an infection caused by Mycobacterium tuberculosis. MDR TB is caused by strains of M. tuberculosis resistant to isoniazid and rifampicin.1 XDR TB refers to strains resistant to one or more second-line injectable drugs and any fluoroquinolone, whereas pre-XDR TB refers to strains resistant to either a second-line injectable drug or a fluoroquinolone.1 The implications of MDR TB include prolonged treatment requirements, increased morbidity and mortality, and risk of onward transmission to others.2 Case history A woman in her forties with poorly controlled diabetes was admitted to hospital three times in 3 months with respiratory symptoms and pulmonary consolidation. She was treated for recurrent community acquired pneumonia (CAP). On her fourth admission, sputum and stool microscopy detected acid fast bacilli (AFB) and PCR using Xpert MTB/RIF (Cepheid® GeneXpert® systems) confirmed M. tuberculosis with resistance to rifampicin. She had no known TB contacts but had had a 5 week holiday in Goa, India, 2 years prior. Management Phenotypic testing confirmed the M. tuberculosis isolate was resistant to rifampicin, isoniazid and aminoglycosides but susceptible to fluoroquinolones. Following discussion with the British Thoracic Society (BTS) MDR TB advice service she was empirically initiated on linezolid 600 mg BD, bedaquiline 200 mg OD, levofloxacin 1000 mg OD, clofazimine 200 mg OD, cycloserine 250 mg BD, pyrazinamide 2000mg OD, ethambutol 1000 mg OD and…
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