Adam – Belgium

Adam is from a region of Somalia where TB is common. There, he had a close relationship with an aunt, who suffered from a severe cough. When Adam was six years old, he and his father moved to Belgium.

Five months later, weighing just 16 kg (35 lbs) and experiencing symptoms of illness, Adam was diagnosed with TB. Adam, like many other children, had trouble producing the sputum normally used to culture the TB organism and determine whether it is drug-resistant. His doctors in Belgium therefore had to perform gastric aspiration to obtain a culture to test for TB. One month and three gastric aspirations later, Adam’s doctors discovered that his strain of TB was in fact resistant to all four first-line drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide), as well as two other commonly used TB drugs (streptomycin and rifabutin).

Fortunately, Adam’s doctor was able to start him immediately on treatment for DRTB. Adam began taking pyrazinamide, moxifloxacin, prothionamide, and amikacin, an injectable TB drug. After four months, the lesions on Adam’s lungs disappeared from his X-rays. Another gastric aspirate came back culture-negative, confirming that the TB bacteria in his system had been killed, and Adam’s general status and weight improved.

In terms of his recovery from TB, Adam, now seven years old, is doing well on treatment. His doctor has to closely monitor Adam’s kidney function and hearing, however, as damage to these organs is a potential side effect of the strong medications he is taking. Adam has also developed hypothyroidism as a result of his treatment with prothionamide. In addition to these serious health concerns, throughout the course of his treatment Adam has had to endure nausea and vomiting, painful injections, and swallowing a plethora of pills whose taste he hates.

Despite these complications, Adam was fortunate to access affordable, timely, and quality care, unlike many of his counterparts worldwide. Despite TB’s being uncommon in Belgium, Adam’s physician promptly suspected and diagnosed TB and initiated DST. Moreover, in Belgium, all costs, including expensive second-line drugs and home-based nursing care for daily injections, are covered. Not only did that spare Adam’s family significant expense, but it also allowed for the comfort of home-based treatment. Adam’s caregivers also tried to alleviate his suffering by administering local anesthetics before his normally painful injections. Timely diagnosis, DST, access to medicines, and initiation of treatment—along with thoughtful, patient-centered care—have saved Adam’s life; however, improved treatment options that shorten time to cure, are injection-free, and have fewer side effects are still needed to improve quality of life for children like Adam with DR-TB.

Story Collected by: Guido Groenen, MD, Belgian Lung and Tuberculosis Association (BELTA) – Tuberculosis Network European Trialsgroup (TBNET), Belgium; Sophie Blumental, MD, Pediatric Infectious Diseases Department, Hôpital Universitaire des Enfants Reine Fabiola, Belgium