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Newborns of MDR patient

By Betsy dinawanao | 24 Feb, 2018

can I ask a basic question..

can I add a question... can a newborn of an MDR patient be a candidate for BCG vaccine...? thanks

and; if a child of an MDR patient shows signs and symptoms suggestive of TB, X-ray shows pneumonia, with Negative Rapid Diagnostic Test, what would be the next test that needs to be done or what management can we give?

I am working with the DSTB and monitors various health stations, this is very relevant to me so I will be able to inform the dos and donts in providing BCG vacs in the Health stations.. Most TB patients are very silent about thier treatment, healthcare staff in the community wont be able to assess because of the large populations. In this matter I will be able to remind them the importance of assessing mothers with previous or ongoing treatment in other dots facilities before giving vaccines.

thank you...

Replies

 

Bisimwa Nsibula Replied at 12:06 AM, 25 Feb 2018

Management of MDR-TBtreatment and prevention will need adherence,compliance and who adapted guidelines by reality of country and good monitoring and evaluation,we meet good success by respect indicated treatment and food support of mdr Tb patients
All staff members and will contribute on assessing mothers,health workers may give all drugs,facilities of vaccines,community communications and participation
I know it is not easy but with good information and engaging,we will test prevent,treat mothers and children,treat and vaccine newborn and make good screening,,be carefully to all probably mdr Tb patients With signs and symptoms suggestive of TB,,do not confuse pneumonia with Tb case,analyze carefully X-Ray and make sure if no atypical picture
Try to prevent and treat all mothers TB case,and pedestrians cases
Use Tb guidelines together

Masoud Dara, MD Moderator Replied at 5:04 AM, 25 Feb 2018

Dear Betsy,

Being a MDR-TB contact is not a contraindication to BCG vaccination. Unless the newborn has HIV infection or other contraindications, it is advisable to provide vaccine.

If there are no signs for active TB and the tests have turned out negative and the clinician is sure that it is a pneumonia (responding to non TB tx), then observation and repeating the non-invasive tests could be the best option, however this all depends on the clinical situation and evolution, as dx of TB among children is very difficult. In certain cases, gastric lavage/aspirates can also be useful. https://academic.oup.com/jpids/article/2/2/171/914988

All the best,
Masoud

Marcela Tommasi Replied at 2:10 AM, 26 Feb 2018

DR TB is a microbiological diagnosis. In children is challenging to confirm bacteriologically due to paucibacillary disease. The bacteriological test are often negative (only less than 30-40 % culture positive in symptomatic children. Rapid test are even less sensitive). There are 3 degrees of certainty of DR-TB diagnosis in children:
1. Confirmed DR-TB:
At least 1 of the signs and symptoms suggestive of TB disease and detection of M.tuberculosis from a child with demonstration of genotypic or phenotypic resistance
2. Probable DR-TB:
Diagnosis of probable TB disease and DR-TB contact (> 78-90 % concordance with adult source)
3. Possible DR TB:
Diagnosis of probable TB disease together with either (a) contact of a source case with TB disease who has risk factors for drug resistance or (b) failure of adherent first-line TB treatment


If a child of MDR TB patient shows signs and symptoms of TB and the X-ray is abnormal, the child should be assessed carefully and considered to start DR-TB treatment following the DST result of adult source to design the treatment. (Probably DR-TB).
How old is the children? Could you share a more detailed history and X-Ray picture?

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