Unidade de Infeciologia Pediátrica, Área da Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Reunião Internacional - ESPID 2020 Virtual Meeting
Resumo:
Introdução: Tuberculosis (TB) continues to be a public health problem. Even though in these days it can be preventable and curable, most cases are misdiagnosed. Infants and young children are at higher risk of developing severe disseminated disease and have higher rates of mortality. The various options for intervention while facing this diagnosis are prophylactic treatment, vaccination with BCG, preventive chemotherapy and adequate treatment.
Relato de caso: A previously healthy 3-month-old male infant was admitted due to disseminated tuberculosis. His father and his cousin were diagnosed with pulmonary tuberculosis (TB) 2 months earlier and initiated isoniazid, rifampicin, pyrazinamide and ethambutol (HRZE) and HRZ, respectively. The drug susceptibility test for Mycobacterium tuberculosis (DST-MT) was ongoing by the time they were discharged and the other houseold contacts, were not screened. On the following month his siblings became symptomatic and were also diagnosed with TB. Our patient initiated chemoprophylaxis with isoniazid but no imaging exams were performed. After 3 weeks disseminated TB (pulmonary, ganglionic and meningeal) was diagnosed. We contacted the father’s hospital in order to know his DST-MT and it was resistant to H. By this time his father was at home, still bacilliferous, and his cousin got worse and was re-admitted at the hospital. All the antibacillary drug schemes were changed and the infant initiated RZE and levofloxacin.
Conclusões: TB is still a challenge. Besides the prematurely stop of the treatment by the patients, incorrect prescriptions by health care providers also increase the number of drug resistant MT cases. In this case, the diagnosis of a severe form of TB after BCG immunization, rises awareness for the real effectiveness of the vaccine. Appropriate screening and adequate articulation between the different health care services are the key to combat this public health problem.
Palavras Chave: Interferon-gamma release assay; Pediatria; Rastreio; Teste tuberculínico; Tuberculose