A Case of Disseminated Multidrug-Resistant Tuberculosis involving the Brain

Drug-resistant strains of Mycobacterium tuberculosis: cell envelope profiles and interactions with the host

In the past few decades, drug-resistant (DR) strains of Mycobacterium tuberculosis (M.tb), the causative agent of tuberculosis (TB), have become increasingly prevalent and pose a threat to worldwide public health. These strains range from multi (MDR) to extensively (XDR) drug-resistant, making them very difficult to treat. Further, the current and future impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the development of DR-TB is still unknown. Although exhaustive studies have been conducted depicting the uniqueness of the M.tb cell envelope, little is known about how its composition changes in relation to drug resistance acquisition. This knowledge is critical to understanding the capacity of DR-M.tb strains to resist anti-TB drugs, and to inform us on the future design of anti-TB drugs to combat these difficult-to-treat strains. In this review, we discuss the complexities of the M.tb cell envelope along with recent studies investigating how M.tb structurally and biochemically changes in relation to drug resistance. Further, we will describe what is currently known about the influence of M.tb drug resistance on infection outcomes, focusing on its impact on fitness, persister-bacteria, and subclinical TB.

Primary Disseminated Multidrug-Resistant Tuberculosis of the Lungs, Brain, Meninges, and Abdomen: The World's First Case

Tuberculosis is a highly infectious disease. It usually infects the lung, but dissemination to different organs results in a severe form of tuberculosis, i.e., disseminated tuberculosis. The situation becomes even more challenging when the infection is due to multidrug-resistant strains of Mycobacterium tuberculosis. The present case is a very rare one where a 17-year-old Indian girl presented with headache, vomiting, cough with expectoration, abdominal pain, and a seizure. A diagnostic workup led to the diagnosis of primary disseminated multidrug-resistant tuberculosis of the lungs, brain, meninges, and abdomen. She has been prescribed an anti-tubercular regimen per the national guidelines.

Primary Disseminated Pre-extensively Drug-Resistant Tuberculosis of the Lungs, Pleura, Chest Wall, and Abdomen: The World's First Case

Drug-resistant tuberculosis is a perpetual threat to public health. In recent years, there has been an increase in the number of cases of this deadly Mycobacterium tuberculosis infection. The present case is a very rare case of primary disseminated pre-extensively drug-resistant tuberculosis of the lungs, pleura, chest wall, and abdomen in a 19-year-old Indian female patient who presented with fever, cough, abdominal pain, and anterior chest wall swelling. The diagnosis was established by a detailed laboratory and radiological workup. An all-oral longer regimen was initiated per national guidelines and according to her weight.