Clinical Report: Effective Management of Pre-XDR-TBMEM in Pregnancy

Overview

This report presents a case of a pregnant woman with pre-XDR-TBMEM successfully treated with a bedaquiline and delamanid regimen. The individualized treatment approach within a multidisciplinary framework resulted in favorable outcomes for both the mother and infant.

Background

Managing drug-resistant tuberculosis (DR-TB) during pregnancy is challenging, especially for severe forms like pre-XDR-TBMEM. The potential teratogenicity of anti-TB drugs complicates treatment decisions, often leading to delays that can jeopardize maternal and fetal health. Newer drugs such as bedaquiline and delamanid offer hope, but robust evidence for their use in this context remains limited.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

• A 33-year-old pregnant woman was diagnosed with pre-XDR-TBMEM complicated by TB-Sepsis and Neuro-IRIS.
• Initial CSF analysis indicated severe meningeal involvement with elevated pressure and cell count.
• Targeted Next-Generation Sequencing confirmed Mycobacterium tuberculosis resistant to multiple first-line and fluoroquinolone drugs.
• An individualized treatment regimen including bedaquiline and delamanid was initiated after confirming drug resistance.
• The patient experienced multi-organ dysfunction but ultimately had favorable outcomes following aggressive treatment.

Clinical Implications

This case underscores the importance of timely and individualized treatment strategies for pregnant patients with severe drug-resistant TB. Clinicians should consider newer anti-TB agents while weighing the risks and benefits for both mother and fetus.

Conclusion

The successful management of pre-XDR-TBMEM in this pregnant patient highlights the potential of bedaquiline and delamanid in complex cases. Further research is needed to establish standardized treatment protocols for similar patients.

References

1. WHO, WHO, 2021 -- Updated Definitions of Extensively Drug-Resistant Tuberculosis
2. WHO, WHO, 2022 -- Consolidated Guidelines on Tuberculosis. Module 4: Treatment - Drug-Resistant Tuberculosis Treatment
3. Open Forum Infectious Diseases, 2022 -- Recurrence and Development of Resistance in Patients Undergoing Innovative Short-Term Treatments for Multidrug-Resistant Tuberculosis in the United States, 2022–2024
4. The Journal of Infectious Diseases, 2023 -- Pharmacokinetic Profile and Safety Assessment of Clofazimine in Pregnant Women with Rifampicin-resistant Tuberculosis: Findings from the IMPAACT P1026s Study
5. The Journal of Infectious Diseases, 2023 -- Safety and Tolerability of a Short Course of Linezolid for the Treatment of Predominantly Moderate to Severe Tuberculous Meningitis in Adults With Human Immunodeficiency Virus
6. Open Forum Infectious Diseases — Evaluation of a Novel All-Oral Short-Term Treatment for Multidrug-Resistant Tuberculosis: Findings from a Semi-Randomized Controlled Trial in China
7. Pregnancy and Birth Outcomes in Patients With Multidrug-Resistant Tuberculosis Treated With Regimens That Include New and Repurposed Drugs
8. WHO announces updated definitions of extensively drug-resistant tuberculosis
9. WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update