Congenital tuberculosis

The role of fiberoptic bronchoscopy in the management of perinatal tuberculosis: a case report

Perinatal tuberculosis is a rare disease with high mortality and a challenging diagnosis. We reported a 56-day-old female infant with cough and wheezing. Her mother had miliary tuberculosis. Gastric aspirate smear, tuberculin skin test, blood and sputum culture of the infant were negative. Thoracic computed tomography demonstrated several consolidated patches with diffuse high-density nodular opacities in bilateral lungs. Fiberoptic bronchoscopy was performed to obtain bronchoalveolar lavage fluid, reduce secretion and restore airway patency on 2 days after admission. Mycobacterium tuberculosis was detected by bronchoalveolar lavage fluid Xpert MTB/RIF and rifampicin resistance was negative on 3 days after admission. Appropriate anti-tuberculosis drug was chosen. The infant made a good recovery. Fiberoptic bronchoscopy plays a vital role in diagnosing rapidly and treating perinatal tuberculosis. And it could be promoted as an important approach to the management of perinatal tuberculosis.

Congenital Tuberculosis: A silent foe

Tuberculosis is a very common disease in India affecting thousands of people, though congenital transmission is very rare and not well known to most clinicians. We present a ten week old infant who presented with marked cervical lymphadenopathy, fever, failure to thrive, hepatosplenomegaly, and bilateral chest crepitations. Investigations were positive for mycobacterium tuberculosis. The baby showed significant improvement to treatment and could be discharged home.

High latency of tuberculosis manifestation in a premature extremely low birth weight infant with favorable outcome

We report a case of possible congenital tuberculosis in a 22+2 weeks, 460 g, vaginally delivered female infant born to a mother suffering from tuberculous endometritis, diagnosed soon after delivery. At 156 days of age, Mycobacterium tuberculosis was detected via PCR from the infant's gastric juice and was subsequently isolated. There was no evidence for horizontal transmission. Mother and child were treated successfully. This case illustrates the possibility of significant latency between infection and clinical manifestation in preterm infants and also emphasizes the need for urgent treatment of neonates in such situations.

Maternal mortality associated with tuberculosis-HIV-1 co-infection in Durban, South Africa

OBJECTIVES

To document the impact of tuberculosis and HIV-1 on maternal mortality.

DESIGN

Prospective study, 1997 and 1998; retrospective analysis, 1996.

PARTICIPANTS

Known maternal deaths, defined as the death of a mother within a year post-delivery, were studied in Durban, KwaZulu Natal. The HIV-1 status, presence of tuberculosis, maternal clinical features and perinatal outcomes were documented. The overall as well as HIV-1 and tuberculosis-specific maternal mortality rates for the hospital were calculated. The attributable fraction of deaths as a result of HIV-1 was calculated in the overall group and in those with tuberculosis co-infection.

RESULTS

A total of 50 518 deliveries and 101 maternal deaths were recorded. Of the deaths, 29.7% (30/101) were HIV-1 infected. The overall mortality rate was 200/100 000; for HIV-1-infected women this was 323.3/100 000, HIV-1-negative mothers, 148.6/100 000 live births. The attributable fraction of overall deaths as a result of HIV-1 was 15.9% Fourteen of the 15 mothers with tuberculosis were HIV-1 co-infected. The mortality rate for tuberculosis and HIV-1 co-infection was 121.7/1000; for tuberculosis without HIV-1 co-infection, 38.5/1000. Fifty-four per cent of maternal deaths caused by tuberculosis were attributable to HIV-1 infection. Thirty-five per cent of maternal deaths were associated with stillbirths; perinatal outcomes were no different between groups of mothers with tuberculosis, HIV-1 or neither infection.

CONCLUSION

Tuberculosis and HIV-1 are emerging as significant contributors to maternal mortality in KwaZulu Natal. Any attempt to improve maternal health must also include careful screening and investigation for tuberculosis in high-risk pregnant women.

Current issues in maternal and perinatal tuberculosis: impact of the HIV-1 epidemic

Human immunodeficiency virus type 1 (HIV-1) and tuberculosis (TB) are among the leading causes of disability and death in the developing world, the largest burden borne by sub-Saharan Africa and Asia. Both diseases are significant among women of childbearing age, and TB, although uncommon in pregnancy, is on the increase. While earlier reports were contradictory regarding the effect of TB on the course of pregnancy and vice versa, the negative impacts of each on the other have been documented, some in relation to HIV-1 co-infection. This review focuses on emerging data on maternal and perinatal TB within the context of HIV-1 infection.