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Matsuda A, Nishizaki N, Abe H, Mizutani A, Niizuma T, Obinata K, Oguma K, Makino S, Ishitate M, Shimizu T. An infant of 26 weeks gestation with congenital miliary tuberculosis complicated by chronic lung disease requiring CPAP was diagnosed on Day 104 of life: congenital tuberculosis was confirmed by detection of calcified ovaries in his mother. Paediatr Int Child Health 2022; 42:72-77. [PMID: 35588163 DOI: 10.1080/20469047.2022.2076030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Early diagnosis of tuberculosis (TB) in infants is important but is commonly missed because the symptoms are often non-specific. CASE PRESENTATION A Nepalese male infant born at 26 weeks gestation and weighing 1227 g (97th centile) was admitted to the neonatal intensive care unit (NICU) immediately after birth for the management of his prematurity. After extubation on Day 8, his oxygen saturation became unstable and he required nasal continuous positive airway pressure with oxygen for 3 months. On Day 104, further detailed evaluation was required because there was no improvement in his respiratory condition. A computed tomography (CT) scan demonstrated scattered miliary nodules in both lung fields. Acid-fast staining for the mycobacteria and TB polymerase chain reaction (PCR) of the sputum obtained directly by laryngeal aspiration confirmed Mycobacterium tuberculosis. On Day 105, he was therefore transferred to a tertiary care hospital for further intensive care. Pathology findings suggested placental involvement with TB owing to chronic endometrial infection. In addition, a maternal abdominal CT scan demonstrated bilateral calcified lesions in the ovaries. He completed antituberculous chemotherapy and was discharged 3 months later. At 18 months of age there are no sequelae and his development is almost normal. None of the infants or medical personnel who were exposed in the NICU developed secondary TB. CONCLUSION In neonates with persistent respiratory distress, neonatologists should consider TB infection as a differential diagnosis. ABBREVIATIONS CLD: chronic lung disease; CRP: C-reactive protein; CT: computed tomography; IGRA: interferon-γ release assay; IVF-ET: in vitro fertilisation-embryo transfer; N-CPAP: nasal continuous positive airway pressure; NICU: neonatal intensive care unit; PCR: polymerase chain reaction; PROM: premature rupture of membranes; TB: tuberculosis; WBC: white blood cells.
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Affiliation(s)
- Akina Matsuda
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naoto Nishizaki
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hanako Abe
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akira Mizutani
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takahiro Niizuma
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kaoru Obinata
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kyoko Oguma
- Department of Obstetrics and Gynaecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynaecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Makoto Ishitate
- Department of Respiratory Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Paediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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Chang CW, Wu PW, Yeh CH, Wong KS, Wang CJ, Chang CC. Congenital tuberculosis: case report and review of the literature. Paediatr Int Child Health 2018; 38:216-219. [PMID: 28421876 DOI: 10.1080/20469047.2017.1315912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Congenital tuberculosis is rare, even where tuberculosis (TB) is endemic. A 14-day-old girl presented with a 3-day history of fever and respiratory distress. Her mother was diagnosed with a disseminated TB infection immediately after the delivery which was confirmed by a positive TB-polymerase chain reaction (TB-PCR) and subsequent culture from ascites and sputum. The infant was separated from her mother at birth. Her chest radiograph showed bilateral miliary nodules. Congenital TB was strongly suspected because of the symptoms, signs and maternal TB history, and was confirmed by TB-PCR and culture from the gastric lavage. Timely administration of standard anti-TB therapy resulted in a good outcome. The case highlights the importance of maternal TB history and typical miliary pattern on chest radiography for early diagnosis of congenital or neonatal TB which in turn facilitates prompt treatment and the prognosis.
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Affiliation(s)
- Ching-Wen Chang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Patricia Wanping Wu
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Chih-Hua Yeh
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Kin-Sun Wong
- b Division of Pediatric Pulmonology, Department of Pediatrics , Chang Gung Children's Hospital , Taoyuan , Taiwan
| | - Chao-Jan Wang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
| | - Chih-Chen Chang
- a Department of Medical Imaging and Intervention , Chang Gung Memorial Hospital, Linkou, Chang Gung University , Taoyuan , Taiwan
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Abstract
ABSTRACT Although tuberculosis (TB) has its highest burden among young adults, especially since the advent of HIV infection, two other groups with low immunity, the very young (<1 year) with immature immunity and the elderly (>65 years) with waning immunity, are vulnerable groups not to be forgotten. This review describes the epidemiology, clinical aspects, public health aspects and outcome of TB in patients at the extremes of age. The epidemiology differs therein that TB in infants occurs in developing countries with high incidences of TB and HIV, while TB in the elderly occurs in developed countries with ageing populations. The clinical presentation may be non-specific, history of contact with TB is often not known and TB is often not considered at these age extremes, and when the diagnosis is considered, disease progression may already be advanced. Anti-TB treatment regimens are the same as in other age groups, but drug dosages may need adjustment according to weight, renal function, liver function and other potentially complicating factors. Adverse events are more difficult to observe and both the young and the elderly are reliant on others for adherence to treatment. Mortality at both age extremes is higher than in the general TB population. For all the above reasons, public health measures to: prevent transmission of infection; identify those infected and providing preventive therapy; high index of suspicion in order to make an early diagnosis; and timely initiation of treatment are important in both the very young and the elderly.
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Affiliation(s)
- H Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South Africa
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Abalain ML, Petsaris O, Héry-Arnaud G, Marcorelles P, Couturaud F, Dobrzynski M, Payan C, Gutierrez C. Fatal congenital tuberculosis due to a Beijing strain in a premature neonate. J Med Microbiol 2010; 59:733-735. [DOI: 10.1099/jmm.0.016881-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Congenital tuberculosis (TB) remains a rare disease but is fatal if untreated. Early detection is difficult because of the non-specific nature of the symptoms in TB during pregnancy and infancy. This report summarizes a case of congenital TB in a very premature infant, born at 25 weeks gestation. Miliary TB was diagnosed in the mother when the neonate was 20 days old. Antituberculous therapy allowed a rapid improvement in the mother. The infant died at 27 days old. A Beijing genotype strain of Mycobacterium tuberculosis was isolated both in the mother, from pulmonary and urine specimens, and in the infant, from peritoneal fluid.
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Affiliation(s)
- M. L. Abalain
- Faculté de Médecine et des Sciences de la Santé, Université de Brest, EA 3882, 29200 Brest, France
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest cedex, France
| | - O. Petsaris
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest cedex, France
| | - G. Héry-Arnaud
- Faculté de Médecine et des Sciences de la Santé, Université de Brest, EA 3882, 29200 Brest, France
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest cedex, France
| | - P. Marcorelles
- Service d'Anatomo-Pathologie, Centre Hospitalier Universitaire Morvan, 2 Avenue Foch, 29609 Brest cedex, France
| | - F. Couturaud
- Service de Pneumologie, Centre Hospitalier Universitaire La Cavale Blanche, 29609 Brest cedex, France
| | - M. Dobrzynski
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire Morvan, 2 Avenue Foch, 29609 Brest cedex, France
| | - C. Payan
- Faculté de Médecine et des Sciences de la Santé, Université de Brest, EA 3882, 29200 Brest, France
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest cedex, France
| | - C. Gutierrez
- Laboratoire de Référence des Mycobactéries, Institut Pasteur, 75015 Paris, France
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Tuberculose congénitale chez le nouveau-né prématuré : à propos d’un cas. Arch Pediatr 2009; 16:439-43. [DOI: 10.1016/j.arcped.2009.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 06/18/2008] [Accepted: 02/02/2009] [Indexed: 11/19/2022]
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Abstract
Genital tuberculosis (TB) is a major cause of infertility in the world, notably in developing countries, but its incidence is increasing in the western continents. In vitro fertilization (IVF) represents a useful treatment of infertility after TB. We report the first case of congenital TB after IVF and suggest improvement of usual screening before and after IVF.
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Premkumar M, Anumakonda V, Cormican L, Ruiz G, Greenough A. Feeding intolerance due to connatal tuberculosis in a prematurely born infant. Eur J Pediatr 2008; 167:955-6. [PMID: 17885763 PMCID: PMC7101876 DOI: 10.1007/s00431-007-0605-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 08/28/2007] [Indexed: 11/28/2022]
Abstract
A prematurely born infant had three episodes of feeding intolerance in the first three weeks after birth. In the post-partum period, his mother, who was from the Ukraine, had a respiratory arrest; unusually, a high-resolution computerised tomograph demonstrated miliary tuberculosis (TB). As a consequence, and due to the continuing ill health of the infant, gastric aspirates were sent from the infant. Acid fast bacilli were seen on microscopy. Variable nucleotide tandem repeat analysis of acid fast bacilli facilitated the rapid diagnosis of connatal TB. We conclude that connatal TB should be considered in a prematurely born infant poorly responsive to standard management and whose mother falls into a high-risk group.
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Affiliation(s)
| | | | - Liam Cormican
- Department of Chest Medicine, King’s College Hospital, London, UK
| | - Gary Ruiz
- Department of Child Health, King’s College Hospital, London, UK
| | - Anne Greenough
- King’s College London, MRC–Asthma Centre, Division of Asthma, Allergy and Lung Biology, King’s College Hospital, London, UK
- 4th Floor Golden Jubilee Wing, King’s College Hospital, Denmark Hill, London, SE5 9RS UK
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