Javed Iqbal, Raana Haqqee, Fayyaz Hussain.
When a patient with TB does not respond to ATT - suspect MDR TB.
Pak J Chest Med Jan ;7(Suppl):47-8.

A 40 years old female from rural area of Pakistan was treated for pulmonary TB about 12 yrs ago. She took all the medications that were prescribed to her at that time. The drug combination, dose or duration of therapy could not be ascertained accurately. She presented in September 2000 with fever, weight loss and hemoptysis. The CXR showed decreased right lung volume with right mid-lung fibrotic changes and evidence of pleural thickening with cavitation at the right apex. Sputum for AFB smear was positive and she was started on INH, rifampicin, pyrazinamide and ethambutol. With no clinical response in next three weeks streptomycin and ofloxacin were added. She remained febrile and presented with further weight loss in her next visit in clinic three weeks later. Sputum culture report received in first weak of Nov. 2000 showed MTB resistant to four first line agents i.e. INH, Rifampicin, PZA and Streptomycin. The sensitivity report for second line agents was received in first week of Dec. 2000. The mycobacterium was resistant to capreomycin and ciprofloxacin but was sensitive to cycloserine, ethionamide and ethambutol. Her ofloxacin was stopped and she was continued on ethambutol, ethionamide and cycloserine. At her subsequent visit to clinic one-month later she was afebrile, with weight gain of 2 kg, improved appetite and general condition. She is being followed up in the clinic presently and is continuing to show good response.

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