Abstract

Introduction: Tuberculosis (TB) is a global infectious disease, causing approximately 10.6 million new cases and 1.6 million deaths in 2021, with 450,000 patients annually having rifampicin-resistant (RR)/multi-drug resistant (MDR) TB. Despite higher pulmonary TB notifications in males, TB in females remains a significant threat, reflecting potential barriers to healthcare access.

Background: This study addresses the challenging landscape of Rifampicin-resistant extrapulmonary TB in adolescent females, aiming to unravel recurrence patterns and treatment complexities. It serves as a call to action, advocating for tailored interventions to mitigate the impact of drug-resistant TB in this vulnerable population.

Overview: Adolescence poses unique challenges for individuals diagnosed with tuberculosis, especially for females who exhibit higher susceptibility, facing stigma and potential impacts on self-esteem. The presentation of drug-resistant tuberculosis in adolescents differs from early childhood, necessitating differentiated care; however, there's a notable lack of recognition and specific guidelines for this age group in national TB programs.

W.H.O. outlines plan with a comprehensive five-year strategy, detailing ten crucial steps to improve tuberculosis prevention, treatment, and care for children and adolescents. Additionally, the Roadmap targets a 90% coverage in diagnosis and treatment services and aims to provide TB preventive treatment to 90% of those at high risk between 2023 and 2027.

Rifampicin-resistant tuberculosis, comprising MDR and XDR types, requires microbiological confirmation through genotypic or phenotypic tests. Treatment in adolescents aligns with adult regimens, including novel drugs like Delanamid and Bedaquiline, with consideration for exposure history and drug susceptibility.

Study Design: Retrospective Observational Study investigating Rifampicin resistance in pediatric/ adolescent tuberculosis, with a focus on extrapulmonary manifestations. Data sourced from OPD Group of TB Hospitals Sewri Mumbai and allied TB clinic in Mumbai jurisdiction.

Case Studies: Case 1: 12-year-old girl, treated for pulmonary TB, developed abdominal symptoms, diagnosed with Rifampicin-resistant TB, started on longer oral regimen.

Case 2: Another 12-year-old girl, treated for TB, developed abdominal symptoms, diagnosed with Rifampicin-resistant TB, initiated on a different oral regimen.

Case 3: 17-year-old girl with enlarged lymph nodes, challenging biopsy during COVID-19, diagnosed with Rifampicin-resistant TB, responded to BDQ-based regimen but persistent lymph node size after 18 months.

Discussion: This case series underscores the challenges of managing tuberculosis in young female adolescents, revealing insights into recurrence and Rifampicin resistance. It emphasizes the necessity for vigilant monitoring, personalized approaches, and ongoing research to optimize outcomes in combating this resilient pathogen.

In Summary, this study highlights the urgent need for targeted interventions and heightened clinical awareness in addressing drug-resistant extrapulmonary tuberculosis among pediatric/adolescent females. The findings underscore the importance of exploring socio-economic determinants for comprehensive public health initiatives to mitigate the impact of TB in vulnerable

Keywords: Female Adolescent, Extra-Pulmonary TB, Rifampicin Resistance (RR TB)