Conclusion
A rare case of MDR-TB cervical lymphadenitis in a 2-month male infant
was reported from the mother with pulmonary TB. According to results ofMtb strains genotyping, it was determined that his mother was
infected by the multiple Mtb strains and possibly the infant boy
was infected with regards to the congenital-TB route rather than the
environment. Congenital TB symptoms were various in the infants and it
could be converted to TB-disseminated infection. There was no evidence
of disseminated infection for the present case using radiological
findings, laboratory indexes and bacterial culture testing.
Surprisingly, we confronted with an MDR-TB infant case delivered from a
drug-susceptible pulmonary-TB mother case, which is quite uncommon. The
physician decision was initiated with the first-line anti-tuberculosis
therapy without the DST (Drill Stem Test) result due to time-consuming
aspect of the Mtb culture and this peculiar emergency case.
However, we performed DST by the molecular techniques and identified
that the infant was an MDR-TB case. There are several points to be
considered in this case, which including (i) Iran is TB endemic region
and it is necessary to introduce new local TB control programs such as
performing DST and anti-tuberculosis regimen should be recommended based
on the DST pattern in such a region; (ii) Clinical manifestations of
cervical tuberculosis lymphadenitis were not very unique and could be
confused with other infections, particularly in the absence of the
response to Category I anti-TB regimen treatment due to the DR-TB
infection, as in the present case; (iii) The fine needle aspiration
(FNA) technique with the molecular methods can diagnose the cervical
tuberculosis lymphadenitis cases with great accuracy; (iv) Although the
DR-TB strains should be diagnosed quickly, the cervical tuberculosis
lymphadenitis infections caused by these strains are not usually fatal,
in case they are properly administered and given antibiotic-based drug
susceptibility testing; (v) Fluoroquinolone is an appropriate
therapeutic agent for the prophylactic aspect of contacts with the
MDR-TB cases.