Semmi – South Korea

The name of the child in this story has been changed to protect confidentiality.

Semmi’s father had been on irregular TB treatment for years, but Semmi’s battle with TB began in 1996. At eight years old, Semmi tested positive for TB infection. Semmi likely acquired this latent infection from her father. She received preventive therapy with the firstline drug isoniazid to stop the infection from progressing to active disease, but was given isoniazid for only four months (rather than the recommended nine months of treatment).

Semmi’s family’s struggle with TB did not end then. In 1998, when Semmi was 10 years old, her mother was diagnosed with MDR-TB and her brother was diagnosed with drug-sensitive TB (DS-TB). Eventually, Semmi’s mother and brother were cured of TB, but her father unfortunately died of XDR-TB.

In 2001, Semmi was 13 years old and experiencing symptoms of illness. In March, she was diagnosed with TB and began treatment with isoniazid, rifampicin, ethambutol, and pyrazinamide. After three months of treatment, Semmi’s chest X-rays did not improve, and her doctors switched her to a regimen of second-line drugs to treat what they suspected was DR-TB. Semmi kept up with her second-line therapy for eight months. In February 2002, she began having trouble taking her treatment regularly and stopped treatment altogether.

Two years later, in May 2004, Semmi returned to her doctor in poor condition. Her chest X-rays showed cavitary lesions in the lungs (or holes where TB had destroyed the lung tissue). Semmi’s doctor reinitiated her on second-line treatment, but Semmi had problems taking her medications, which resulted in several interruptions in her treatment.

Finally, in June 2005, Semmi’s doctor performed DST. A month later, the results showed her strain of TB was resistant to nearly all TB drugs: isoniazid, rifampicin, ethambutol, kanamycin, capreomycin, PAS, ofloxacin, moxifloxacin, and rifabutin. Semmi had extensively drug-resistant tuberculosis (XDR-TB).

In January 2007, Semmi had surgery to remove the cavitary lesions from her lungs. In September 2011, Semmi’s doctor initiated her on a new regimen including linezolid. At first, Semmi showed signs of improvement; however, Semmi became anemic, and her doctors had to lower the dose of her TB medications. In summer 2012, after spending 16 years fighting TB, Semmi died of chronic XDR-TB.

Story Collected by: Myungsun Lee, MD, International Tuberculosis Research Center (ITRC), South Korea