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Rifampin-Resistant Mycobacterium bovis BCG–Induced Disease in HIV-Infected Infant, Vietnam

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To the Editor: Guidelines for the diagnosis and management of Mycobacterium bovis BCG disease in HIVinfected children are lacking. BCG strains are intrinsically resistant to pyrazinamide and in some cases have low-level resistance to isoniazid (6). However, data on acquired drug resistance in M. bovis BCG are limited. We describe a case of BCG disease caused by a rifampin-resistant strain of M. bovis BCG in an HIV-infected infant in Vietnam. The daughter of a known HIVinfected woman, who did not fully adhere to antiretroviral therapy (ART) during pregnancy, received the M. bovis intradermal BCG (Pasteur strain) vaccine at birth. HIV infection was diagnosed in the infant by PCR when she was 8 weeks of age. At 9 months of age, she was admitted to the Pediatric Infectious Diseases Department of the Pham Ngoc Thach Hospital (Ho Chi Minh City, Vietnam) because of a voluminous ipsilateral axillary mass at the site of the vaccination, fever, weight loss, and hepatosplenomegaly. The percentage of CD4+ T cells was 27 (1,620 cells/mm3). Regional BCG disease was clinically diagnosed without microbiological investigation, and a broad antimycobacterial therapy targeting M. tuberculosis complex species was started with 5 mg/kg isoniazid, 10 mg/kg rifampin, and 25 mg/kg pyrazinamide. After 6 weeks of antimycobacterial therapy, ART was initiated with lamivudine, stavudine, and abacavir.

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