Three Cases of Multidrug-resistant Tuberculosis in Children in Hasan Sadikin Hospital Bandung Indonesia: How we Find the Cases?

Background: Increasing in adult MDR-TB cases may increase MDR-TB cases in children, because MDR-TB in children is mainly caused by transmission of drug-resistant strains, but the magnitude of this problem is less reported particularly in developing country. Even though until recently limited number of MDR-TB in children were identified globally, a recent systematic review of case series reported MDR-TB in children. In Indonesia, there is no data published and still challenging in diagnosis and treatment. Although we have MDR-TB children guideline adopted from WHO, it is difficult to implement in our setting because of lack laboratory facilities.

Case Reports: Three cases of MDR-TB were diagnosed within the last year of the total 170 adult MDR-TB, which is our first clinical experience in diagnosing and treating MDR-TB in children. All three patients were female, one of them was under five years old. Two cases presented with chronic cough and one with scrofuloderma. One identified through contact investigation, and the others based on suspicion MDR-TB cases due to history of lost to follow up TB treatment and relapse of TB disease, respectively. However, the later two had no identified MDR-TB contact. Diagnoses of MDR-TB mainly based on GeneXpert MTB/RIF examination and DSTs. All patients are now still ongoing treatment with standard MDR-TB regimen, except one case of which treated with individual regimen due to sensory neural hearing loss identified before treatment start.

Conclusion: MDR-TB in children should be identified both by case finding of MDR-TB adult contacts and exploration history of lost to follow up and relapse of TB disease. It is noted that GeneXpert MTB/RIF is important in diagnosing MDR-TB in children.