• T A Thomas, S V Shenoi, S K Heysell, F J Eksteen, V B Sunkari, N R Gandhi, G Friedland, and N S Shah.
• Tugela Ferry Care and Research Collaboration, Tugela Ferry, KwaZulu-Natal, South Africa.
• Int. J. Tuberc. Lung Dis. 2010 Oct 1; 14 (10): 1244-51.

SettingExtensively drug-resistant tuberculosis (XDR-TB) has been documented worldwide, but reports of XDR-TB in children are extremely limited.ObjectiveTo report the characteristics of pediatric XDR-TB patients in rural South Africa.DesignWe retrospectively reviewed children with sputum culture-confirmed XDR-TB from Tugela Ferry, South Africa, from January 2006 to December 2007. Demographic, clinical and microbiologic data were abstracted from medical records.ResultsFour children aged 6-8 years with XDR-TB were reviewed. Two had previous histories of TB. All were human immunodeficiency virus (HIV) infected orphans; three received highly active antiretroviral therapy (HAART) before XDR-TB diagnosis. All had clinical and radiographic improvement and sputum culture conversion while on standardized XDR-TB treatment and HAART. Two tolerated concomitant XDR-TB and HIV treatment well. Two experienced neuropsychiatric side effects related to cycloserine. All have survived >24 months and all were cured. Prior to XDR-TB diagnosis, the children had resided in the hospital's pediatric ward for a median of 8 months (range 5-17), including a 3-month overlapping period.ConclusionsXDR-TB is a microbiologic diagnosis that, even with HIV co-infection, can be successfully identified. Concurrent XDR-TB and HIV therapy is feasible and effective in children, although more research is needed into potential overlapping toxicities. Nosocomial transmission is suggested, calling for infection control policies in pediatric wards.

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