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A case study of 15 years old boy is presented with swelling over left flank for 1 month. Topics include examines ultrasound and MRI spine showed bilateral psoas abscess and left flank abscess and examines flank abscess was aspirated and pus showed acid fast bacillus on smear and considered ge was started on first line anti-tuberculous therapy consisting of isoniazid, rifampicin, pyrazinamide and ethambutol.

Abstract: Out of a total of 311 Mycobacterium tuberculosis isolates from sputum specimens subjected to first- and second-line drug-susceptibility testing (DST) at a hospital serving as a referral center for chronic tuberculosis (TB) cases in New Delhi, 232/311 (74.6%) isolates were found to be resistant to isoniazid and rifampicin. Among multidrug-resistant (MDR) isolates, 119/232 (51.3%) were resistant to four first-line drugs (streptomycin, isoniazid, rifampicin and ethambutol). Mono-resistance to isoniazid was observed in 18 (5.7%) isolates, while none of the isolates tested showed mono-resistance to rifampicin. 50/232 (21.5%) isolates met the definition of extensively drug resistant (XDR) TB, i.e., additional resistance to a fluoroquinolone and at least one of the three injectable second-line drugs: kanamycin, capreomycin, or amikacin. Spoligotyping of the XDR-TB isolates revealed 14 patterns; 39/50 (78%) isolates being grouped in three clusters vs. 11/50 (22%) isolates being unique. SIT1/Beijing represented the largest cluster (n =21, 42%), followed by SIT26/CAS1-Delhi (n =10, 20%) and SIT 53/T1 (n =8 isolates; 16%). This study corroborates recent observations from North India suggesting that both Beijing and CAS1-Delhi lineages constitute the bulk of XDR-TB isolates that are disseminating rapidly across a large geographical region in and around the capital city of India. [Copyright &y& Elsevier]