CASE REPORT Drug-resistant tuberculosis in two children in Greece: Report of the first extensively drug-resistant case Aspasia Katragkou & Charalampos Antachopoulos & Elpis Hatziagorou & Maria Sdougka & Emmanuel Roilides & John Tsanakas Received: 31 March 2012 / Revised: 21 July 2012 / Accepted: 29 July 2012 / Published online: 21 August 2012 # Springer-Verlag 2012 Abstract Extensively drug-resistant (XDR) tuberculosis (TB) represents a serious and growing problem in both endemic and non-endemic countries. We describe a 2.5- year-old girl with XDR-pulmonary TB and an 18-month- old boy with pre-XDR-central nervous system TB. Patients received individualized treatment with second-line anti-TB agents based on genotypic and phenotypic drug susceptibil- ity testing results. Both children achieved culture conversion 3 months and 1 month after treatment initiation, respective- ly. The child with XDR-pulmonary TB showed evidence of cure while treatment adverse events were managed without treatment interruption. The child with pre-XDR-central ner- vous system TB after 6-month hospitalization with multiple infectious complications had a dismal end due to hepatic insufficiency possibly related to anti-TB treatment. This is the first report of children with pre-XDR and XDR TB in Greece, emphasizing the public health dimensions and man- agement complexity of XDR TB. Keywords Tuberculosis . Children . Extensively drug- resistant . Multidrug-resistant . Pneumonia . Central nervous system Introduction Childhood tuberculosis (TB) accounts for approximately 10– 15 % of the global TB burden [9]. Little is known about the prevalence of resistant TB cases in children while the bulk of the up-to-date data come from adult studies [13, 15, 16]. Reports from South Africa showed a high and rising preva- lence of anti-TB drug resistance in children [15]. Multidrug- resistant (MDR) TB means resistance to at least isoniazid and rifampicin; XDR TB means resistance to isoniazid and rifam- picin plus to a fluoroquinolone and at least one second-line injectable agent (amikacin, kanamycin, and/or capreomycin), and pre-XDR TB means resistance to isoniazid and rifampicin and either a fluoroquinolone or second-line injectable agent but not to both. The highest proportion of XDR cases and the most severe drug resistance patterns occur in countries of the former Soviet Union [8]. Developed countries report cases of drug-resistant TB due to immigration from countries with high incidence of drug-resistant TB [11]. Αlthough the total number of new TB cases per year steadily declined in Greece since 2000 and new cases among Greeks followed a similar trend, the total number of new cases in immigrants increased almost sixfold [10]. In addition, despite a high degree of under-notification in the national TB monitor- ing system, the absolute number of resistant cases among immigrants is increasing [7, 10] and, indeed, is among the highest compared to other western European countries [10, 23]. In this article, we present two pediatric patients with XDR and pre-XDR TB, which are the first cases reported in our country; the seriousness and complexity of this dis- ease are discussed. Patient 1 A previously healthy 2.5-year-old girl was diagnosed with pulmonary TB in a district hospital. Initially, diagnosis was A. Katragkou : C. Antachopoulos : E. Hatziagorou : E. Roilides : J. Tsanakas 3rd Department of Pediatrics, School of Medicine, Aristotle University, Thessaloniki, Greece M. Sdougka Pediatric Intensive Care Unit, Hippokration Hospital, Thessaloniki, Greece E. Roilides (*) 3rd Department of Pediatrics, Hippokration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece e-mail: roilides@med.auth.gr Eur J Pediatr (2013) 172:563–567 DOI 10.1007/s00431-012-1811-8