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First Use of Bedaquiline in Democratic Republic of Congo: Two Case Series of Pre Extensively Drug Resistant Tuberculosis

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Journal of Tuberculosis Research 2018年第2期6卷 125-134页

作者： Murhula Innocent Kashongwe Leopoldine Mbulula Brian Bakoko Pamphile Lubamba Murielle Aloni Simon Kutoluka Pierre Umba luc lukaso Michel Kaswa Jean Marie Ntumba Kayembe Zacharie Munogolo Kashongwe Kinshasa University Hospital Kinshasa Democratic Republic of Congo Action Damien Centre d’Excellence Damien Kinshasa Democratic Republic of Congo Coordination Provinciale de Lutte contre la Tuberculose Kinshasa Democratic Republic of Congo National Tuberculosis Program Kinshasa Democratic Republic of Congo

In this manuscript the authors have studied the first two patients who were successfully treated with the treatment regimen containing Bedaquiline as second-line drug. The patients were diagnosed with pre-extensively drug-resistant tuberculosis (preXDR TB) whose prognosis was fatal in Democratic Republic of Congo (DRC). Bedaquiline is arguably one of the molecules of the future in the management of ultra-resistant tuberculosis. However, a larger cohort study may help to establish its effectiveness. Case report: Patients 1, 29 years old, with a history of multidrug-resistant TB (MDR-TB) one year previously. He showed signs of TB impregnation again 6 months after the last treatment. Bascilloscopy was positive again. The pre-extensively tuberculosis (pre-XDR TB) diagnosis was made by the Hain test (GenoType®MTBDRsl, Hain Lifescience). Patient 2, brother of the first patient, with a history of MDR TB a year before. He had low back pain with right parietal dorso swelling four months after the last treatment. The x-ray of the column showed L4-L5 disc disease. Parietal ultrasound showed a parietal abscess to the right of thoracic vertebrae with fistulization. Surgical biopsy and pus culture confirmed the diagnosis of Pre-XDR Extrapulmonary TB. The treatment regimen was the same for both patients: 6 months with Amikacin (Am) Bedaquiline (Bdq) Prothionamide (Pto) Paraamino Salicylic acid (PAS) Linezolid (Lzd) Cycloserine (Cs) Pyrazinamide (Z) and 14 months with PAS Lzd Cs Z. The side effects were minor. Bacteriological controls (smears and cultures) after 20 months of treatment are negative to date.

关键词： Pre-XDR TB Pott’s Disease Bedaquiline Molecular Technique Loweinstein Culture

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