Extrapulmonary Drug Resistant Tuberculosis in Zambia: Case Reports on the First Two Recorded Cases

Abstract

Extrapulmonary drug resistant tuberculosis (DRTB) is a rare manifestation of disseminated tuberculosis which carries high mortality more so if the central nervous system (CNS) is affected. This paper reviews two cases of extrapulmonary DR-TB, involving two males both aged 32 years and both human immunodeficiency virus (HIV) positive. The first case presented with fever and had meningeal signs while the second case was a prisoner who presented with recurrent anterior chest wall abscesses respectively. The cerebrospinal fluid (CSF) from the first patient and aspirate of the abscess from the second patient were subjected to nucleic acid amplification  assays with Xpert® MTB/RIF assay (Cepheid, CA, USA) and both results showed mycobacterium positive, with rifampicin resistance detected in low titers. Both patients were initiated on all oral long regimen containing bedaquiline (BDQ) and linezolid (LZD) as core drugs. Both patients showed tremendous improvement and were almost symptom free at month three of treatment and had  returned to full functional status with no apparent adverse effects. This shows the importance of high clinical inquisition and the need for clinicians to subject various bodily fluids to culture and molecular testing including GeneXpert analysis.

Keywords: cold abscess, drug resistance, extrapulmonary, meningitis, tuberculosis