Tajikistan: MSF treats youngest ever MDR-TB patient
Few children at the paediatric tuberculosis hospital in
“Shirinmo is not the youngest child we have seen with tuberculosis, but she is the youngest patient we have diagnosed with MDR-TB,” says Dr Christoph Hoehn of Médecins Sans Frontières (MSF), which opened its children’s MDR-TB project in
Shirinmo’s diagnosis is the latest in a series of firsts for the MSF team. The baby was diagnosed using two new rapid detection methods introduced at the hospital in February 2013. With sputum induction, patients inhale a saline solution which loosens the sputum in their lungs. The sputum is then easily suctioned out. The method is safe to use on babies as young as one month old. Their sputum is then screened with GeneXpert, a new test for TB drug-resistance, which has cut the diagnosis time from 42 days to just two hours.
MSF has also started formulating MDR-TB drugs specifically for children at a pharmacy in
In order to beat the disease, the little girl faces a huge challenge: for the next 18 months, she will have to swallow the syrup along with two other oral drugs; and for six of those months, she will also have injections of another drug. The treatment is so long, difficult and unpleasant that most adults have great trouble sticking to it. Fortunately, Dr Hoehn says that children often have an easier time. “Children suffer less from the common side effects, which are nausea, vomiting and joint pain,” he says.
One side effect of the injectable drugs is hearing problems, which affect up to half of all patients, and cause permanent deafness for some. The effect on children is not known. “We have no way to monitor the hearing of patients this young,” says Dr Hoehn.
There is a real lack of information and guidance on treating children with drug-resistant strains of TB. “Children with TB have been neglected for too long, especially children with MDR-TB,” says Grania Brigden, TB adviser for MSF’s Access Campaign. “We need to ensure that any new developments in TB treatment and diagnostics are made quickly available to children, and it is vital that new drugs for MDR-TB have formulations suitable for children.”
Children with TB who are diagnosed quickly and put on appropriate treatment - and who stick to it - have a good chance of being cured. As for Shirinmo, Dr Hoehn says, “Overall, I think her chances are good if her mother can keep her on treatment. Fortunately she is very well nourished, which can often be a problem.” If all goes well, in 18 months from now the team in
MSF currently has 30 children and adolescents on treatment for MDR-TB at its project in
* Patients’ name has been changed.