Starting an All-Oral Longer Regimen in a Primary Multidrug-Resistant Pulmonary Tuberculosis Patient at a District Tuberculosis Center for the First Time: A Rare Case

Abstract

Tuberculosis (TB) is a disease known to mankind for ages. The situation due to this infection in low- and middle-income countries is grave. The coronavirus disease 2019 (COVID-19) pandemic has only added up to the woes. The situation is alarming due to the isolation of drug-resistant Mycobacterium strains in patients with no history of TB. With the inclusion of new drugs for the management of TB, such as bedaquiline (Bdq), prompt diagnosis and management are feasible. The author herein presents the first case of a primary multidrug-resistant pulmonary TB patient managed on an all-oral longer regimen with Bdq started at a district TB center (DTC) for the first time in the pandemic of COVID-19. This case is unique as during the COVID-19 pandemic, healthcare facilities were saturated, and thus starting treatment after admission was very difficult. Also, the chances of cross-infection in TB patients were present due to weak immunity. This case is very important as this novel management at a DTC would help immensely in resource-limited countries where hospital admissions are difficult due to the COVID-19 pandemic and the burden of TB is very high.

Keywords: bedaquiline; covid-19; drug resistance; multidrug-resistant; mycobacterium tuberculosis; tuberculosis.

Figure 1. High-resolution computed tomography (HRCT) of the chest showing multiple coalescing cavitary lesions in the left upper lobe with peri-regional nodular and alveolar opacities and multiple coalescing nodular and alveolar opacities in the right upper lobe.

(A) Multiple coalescing and alveolar opacities in the right upper lobe. (B) Multiple coalescing cavitary lesions in the left upper lobe with peri-regional and alveolar opacities.