Effect of delamanid on interim outcomes of bacteriological conversion amongst pediatric drug resistant tuberculosis cases in India.

AIM: To determine the bacteriological conversion rate after 6 months of Delamanid (DLM) based treatment in children with drug-resistant tuberculosis (DR-TB) and determine factors associated with bacteriological conversion. METHODS: This is a descriptive retrospective study done in children between the age of 6-17 years with DR-TB who received DLM-based therapy from October 2018 to May 2021. The drug resistance pattern of TB was detected using Xpert RIF/MTB and phenotypic drug sensitivity testing (DST) on TB-MGIT culture reports. Follow-up sputum TB MGIT culture was carried out monthly after DLM initiation for 6 months. Factors associated with sputum bacteriological conversion such as age, gender, pulmonary TB (PTB) versus disseminated TB, unilateral or bilateral lung involvement, type of DR-TB, prior treatment failure, and type of DR-TB regimen were analyzed. RESULTS: Sixty patients received DLM of which two had extrapulmonary TB (EPTB) and sputum conversion could not be assessed. The mean age at presentation was 12.69 ± 3.03 years. Five patients (8.3%) died while on DLM treatment. On follow-up, 8 (13.7%) out of 58 patients had no sputum bacteriological conversion after 6 months of DLM initiation of which three patients were on salvage therapy; 46 (79.3%) had sputum bacteriological conversion within 6 months of DLM initiation. CONCLUSION: Sputum bacteriological conversion rate was almost 80% at the end of 6 months of DLM-based treatment.

Maxillary myxoma misdiagnosed as tuberculosis.

We present here the case of a three-year-old girl with a maxillary myxoma misdiagnosed as tuberculosis (TB). She was referred to our TB clinic with fever for seven months and swelling of the left cheek and a positive Mantoux test. Her mother was also on treatment for TB lymphadenitis. The child had been commenced on anti-tuberculous therapy (ATT) two months before, and because of its unusual location of the swelling, we did a Caldwell-Luc procedure and a white gelatinous tissue was obtained which, on histopathological examination, revealed myxomatous tissue and no granulomas. TB culture was negative. The patient was then referred to the ENT department for surgical excision. We present this case, as not all swellings with positive Mantoux test or contact with TB are TB and it is essential to have a tissue diagnosis of TB to prevent unnecessary treatment with ATT drugs.