Grand Rounds

INH Monoresistance tuberculosis with inhA gene resistance - What should be the anti-tuberculosis regimen?

Vaidehi Mehta1, Ira Shah2
1Pediatric TB Clinic, Department of Pediatric Infectious Diseases, B J Wadia Hospital for Children, Mumbai, India, 2Pediatric TB Clinic, Department of Pediatric Infectious Diseases, B J Wadia Hospital for Children,, Mumbai, India

Address for Correspondence: Vaidehi Mehta, 803-804 Natraj Society near Prabhodhan Thakrey hall sodawala lane Borivali (West),400092,Mumbai, India. Email:

Keywords: INH Monoresistance, inhA gene resistance, Disseminated tuberculosis

Clinical Problem:
A 4-year-old boy presented with gradually increasing left axillary swelling for 7 months. There is no fever, cough, loss of appetite or weight loss or contact with a patient having tuberculosis (TB) contact. He had received immunization as per Universal Immunization programme (UIP) schedule including BCG at birth. On examination, weight was 15.5 kg (between 3rd- 50th centile as per World Health Organisation (WHO) growth charts) and height was 97 cm (between 3rd- 50th centile as per WHO growth charts ). There was a left axillary non-tender, matted and mobile swelling. Systemic examination was normal. Hemogram showed haemoglobin of 9.5 gm/dL, total leucocyte count of 13690/cumm (61% neutrophils and 30% of lymphocytes) and platelets 644 x 10^3/ul. Erythrocyte sedimentation rate (ESR) was 134 mm/hr. Chest Xray showed right upper and middle zone consolidation. Ultrasound (USG) of the swelling and abdomen showed small hypoechoic node in bilateral axilla, measuring 8 x 6 mm and 9 x 3 mm, central echogenic hilum maintained. HRCT chest showed subsegmental consolidation in anterior segment of right upper lobe with air bronchogram, multifoci of intraparenchymal coarse calcification within consolidation. Ill defined- multiple conglomerated mediastinal lymph node present. Right hilar lymphadenopathy was seen causing narrowing of middle lobe bronchus and multiple enlarged lymph node in left axilla. An excision of the axillary node was done that showed mycobacterium tuberculosis (MTB) with no rifampicin resistance on Xpert MTB/Rif assay. Histopathology of the node showed chronic granulomatous lymphadenitis extending upto subcutaneous tissue compatible with TB. Child was started on first line anti-tubercular therapy (ATT) comprising of Isoniazid (INH), Rifampicin (RIF), Pyrazinamide and Ethambutol. On follow up with Line Probe Assay (LPA) report showed resistance to inhA gene and sensitive to rpob and KatG gene and 6 week MGIT showed growth of MTB. Child was diagnosed as disseminated tuberculosis with INH monoresistance with inhA gene resistance and KatG gene susceptible.

What treatment regimen should be given in a child with disseminated TB with INH mono-resistant with inhA gene resistance and KatG gene sensitive?

Previous Grand Rounds View All

Is it Congenital toxoplasmosis?
Suhani Jain, Ira Shah
A 1 month old male child delivered by lower section cesarean section (LSCS) at 8 ½ months of gestation in view of Meconium stained liquor with a birth weight of 2.09 kg was referred in view of a posit....
Recurrent abdominal pain - Diagnostic dilemma
Suhani Jain, Ira Shah
A 6-year-old boy presented with recurrent abdominal pain for 1 ½ years. He had history of soiling of his pants on passing stools on consumption of certain foods such as milk, cookies, and chocolates. ....
A 5 years old girl with suspected Celiac disease
Suhani Jain, Ira Shah
A 5 ½ years old girl presented with recurrent diarrhea since 1 year of age. Her stool was watery and the frequency was about 4-5 times/day. She was treated symptomatically with multivitamin and multim....
A 3 months old with pneumonia and positive cytomegalovirus IgM
Suhani Jain, Ira Shah
Problem - A 3 ½ month-old female infant on exclusive breast feeds presented with constipation for 4 days. She had pneumonia 15 days ago which was treated with IV Ceftriaxone and IV amikacin for 7 days....
A mother with bad obstetric history - Is it due to cytomegalovirus?
Suhani Jain, Ira Shah
A 32-year-old pregnant female at 9.5 weeks of gestation presented for ruling out fetal deaths due to intrauterine infection. She has a bad obstetric history with a medical termination of pregnancy (MT....
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0