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Dosing and Monitoring of Isoniazid in a Preterm, Extremely Low Birth Weight Infant After In Utero Exposure to Mycobacterium tuberculosis: A Case Study and Literature Review. Pediatr Infect Dis J 2022; 41:967-969. [PMID: 36375097 DOI: 10.1097/inf.0000000000003718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sun JM, Wang C, Jin DQ, Deng F. Fatal congenital tuberculosis owing to late diagnosis of maternal tuberculosis: case report and review of congenital tuberculosis in China. Paediatr Int Child Health 2020; 40:194-198. [PMID: 32195623 DOI: 10.1080/20469047.2020.1743932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Congenital tuberculosis (TB) is rare and the prognosis is poor if not detected early. The diagnosis is often delayed owing to non-specific clinical presentation, misdiagnosis and undiagnosed maternal TB during pregnancy. A 12-day-old girl presented with a 5-day history of fever, cough, poor feeding and respiratory distress. Her mother had a cough and fever at 30 weeks gestation which was managed empirically as community-acquired pneumonia without a TB workup. Immediately postpartum, her mother developed a high fever and shortness of breath and required admission to the intensive care unit. The infant was separated from her mother after delivery. The infant's chest radiograph showed bilateral miliary nodules. Thoracic and abdominal computed tomography (CT) showed multiple enlarged lymph nodes and congenital TB was suspected. Early morning gastric aspirate and sputum (obtained through a suction tube) were positive for acid-fast bacilli on smear microscopy and subsequently Mycobacterium tuberculosis was cultured from both specimens. Lumbar puncture was performed and cerebrospinal fluid (CSF) was compatible with TB meningitis. TB-polymerase chain reaction (TB-PCR) was positive. Her mother was diagnosed with miliary TB on postpartum day 17. Both were given anti-TB chemotherapy. Unfortunately, despite the treatment, the infant died from multiple organ dysfunction syndrome (MODS) caused by congenital TB at the age of 14 days. This case highlights the importance of screening pregnant women for TB in regions where it is highly prevalent. A high index of suspicion of maternal and congenital TB is critical to early diagnosis, especially in such regions.
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Affiliation(s)
- Jing-Min Sun
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University , Anhui, China
| | - Chang Wang
- Department of Radiology, Anhui Province Children's Hospital , Anhui, China
| | - Dan-Qun Jin
- Department of Pediatrics, Anhui Province Children's Hospital , Anhui, China
| | - Fang Deng
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University , Anhui, China
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Abstract
BACKGROUND Congenital tuberculosis (TB) is rare in the United States. Recent immigration patterns to the United States have made the diagnosis of congenital TB an important public health issue. PURPOSE To explore the epidemiology, pathophysiology, diagnostic evaluation, treatment, and prognosis for congenital TB. The implications for exposed healthcare professionals in the neonatal intensive care unit (NICU) setting are also explored. METHODS/SEARCH STRATEGY Relevant articles were accessed via PubMed, CINAHL, and Google Scholar. FINDINGS/RESULTS Until 1994, fewer than 400 cases of confirmed congenital TB had been reported in the literature worldwide. An additional 18 cases were reported from 2001 to 2005. Neonatal providers need to be aware of the potential for congenital TB infection as the immigrant population in the United States continues to increase, many of whom originate from TB endemic countries. IMPLICATIONS FOR PRACTICE The interpretation of TB-specific tests is problematic in newborns due to decreased sensitivity and specificity. Congenital TB should be ruled out in infants with signs and symptoms of sepsis or pneumonia and in whom broad-spectrum antibiotic therapy does not improve their clinical status. IMPLICATIONS FOR RESEARCH The interpretation of TB-specific tests is problematic in newborns due to decreased sensitivity and specificity; more research is needed regarding best practice in diagnosis. Established protocols are needed to address the healthcare of TB-exposed providers in the NICU.
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Samedi V, Field SK, Al Awad E, Ratcliffe G, Yusuf K. Congenital tuberculosis in an extremely preterm infant conceived after in vitro fertilization: case report. BMC Pregnancy Childbirth 2017; 17:66. [PMID: 28219359 PMCID: PMC5319084 DOI: 10.1186/s12884-017-1256-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/07/2017] [Indexed: 05/29/2023] Open
Abstract
Background Congenital tuberculosis is a rare manifestation of tuberculosis. The diagnosis is often delayed, especially in preterm neonates because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy. Case Presentation We report a case of congenital tuberculosis in an infant born at 24 weeks of gestation to a mother who presented with uncontrolled seizures during preterm labor. Maternal diagnosis was initially made by placental pathology, and later confirmed by isolation of Mycobacterium tuberculosis in urine, gastric aspirates and sputum. Full screening was performed on the newborn infant, and both mother and infant were successfully treated for tuberculosis with a four drug regimen. Conclusion Pregnancy can exacerbate latent tuberculosis and women originating from endemic areas are especially susceptible. The best way to prevent congenital tuberculosis is to have a high index of suspicion and identify and treat tuberculosis in pregnant women.
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Affiliation(s)
- Veronica Samedi
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen K Field
- Department of Medicine, Section of Respiratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Essa Al Awad
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gregory Ratcliffe
- Department of Radiology, Section of Neuroradiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Radiology, Section of Neuroradiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,, Rm 273, Heritage Medical Research Building 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Khorsand Zak H, Mafinezhad S, Haghbin A. Congenital Tuberculosis: A Newborn Case Report With Rare Manifestation. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e23572. [PMID: 28184323 PMCID: PMC5291933 DOI: 10.5812/ircmj.23572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 06/12/2015] [Accepted: 08/22/2015] [Indexed: 11/21/2022]
Abstract
Introduction Congenital tuberculosis is an infrequently encountered condition and only 300 cases were reported in the literature till 1989. There are no specific signs and symptoms pathognomonic for congenital TB, and the devastating consequences in the absence of early therapy signify the importance of early diagnosis and treatment during the neonatal period. Case Presentation In this paper we report on a case of congenital TB in a newborn who was admitted to our clinic with seizures and intraventricular hemorrhage (IVH) due to TB meningitis. Her mother was diagnosed with active pulmonary TB and treated with a multi-drug anti-tuberculosis regimen. Her screening for human immunodeficiency virus (HIV) was negative. Cerebrospinal fluid was collected and showed protein levels at 300 mg/dL, glucose at 27 mg/dL (serum glucose level was 76 mg/dL), many RBC, and a positive result for acid-fast bacilli on smear microscopy, all of which were compatible with tuberculous meningitis. Conclusions It is important to consider TB meningitis in newborns with perinatal IVH and concomitant hydrocephalus particularly when the mother has a history of TB prior to or during pregnancy.
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Affiliation(s)
- Hadi Khorsand Zak
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, IR Iran
| | - Shahin Mafinezhad
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, IR Iran
- Corresponding Author: Shahin Mafinezhad, Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, IR Iran. Tel: +98-9153101504, E-mail:
| | - Ali Haghbin
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, IR Iran
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6
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Mony VK, Polin J, Adler E, Munjal I, LaTuga MS, Kojaoghlanian T. Congenital Tuberculosis: A Missed Opportunity. J Pediatric Infect Dis Soc 2014; 3:e45-7. [PMID: 26625463 DOI: 10.1093/jpids/piu029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/18/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Vidya K Mony
- Department of Pediatrics Division of Infectious Diseases
| | | | - Esther Adler
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Iona Munjal
- Department of Pediatrics Division of Infectious Diseases
| | - Mariam Susan LaTuga
- Department of Pediatrics Division of Neonatology, Children's Hospital at Montefiore, Bronx, New York
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Espiritu N, Aguirre L, Jave O, Sanchez L, Kirwan DE, Gilman RH. Congenital transmission of multidrug-resistant tuberculosis. Am J Trop Med Hyg 2014; 91:92-5. [PMID: 24821847 PMCID: PMC4080578 DOI: 10.4269/ajtmh.13-0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022] Open
Abstract
This article presents a case of multidrug-resistant tuberculosis (TB) in a Peruvian infant. His mother was diagnosed with disseminated TB, and treatment commenced 11 days postpartum. The infant was diagnosed with TB after 40 days and died at 2 months and 2 days of age. Congenital transmission of TB to the infant was suspected, because direct postpartum transmission was considered unlikely; also, thorough screening of contacts for TB was negative. Spoligotyping confirmed that both mother and baby were infected with identical strains of the Beijing family (SIT1).
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Affiliation(s)
- Nora Espiritu
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Lino Aguirre
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Oswaldo Jave
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Luis Sanchez
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Daniela E Kirwan
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert H Gilman
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Abstract
Congenital tuberculosis is difficult to diagnose unless there is a high index of suspicion. A 2-month-old infant boy presented with a history of fever since birth and failure to thrive. Chest radiograph demonstrated right upper lobe collapse/consolidation and an ultrasonogram of the abdomen showed multiple hypo-echoic hepatic and splenic lesions, and multiple retroperitoneal nodes. Fine needle aspiration of a cervical lymph node detected acid-fast bacilli (AFB). The mother's chest radiograph demonstrated features of pulmonary tuberculosis. Placental histology detected AFB. The combined clinical and laboratory features in both mother and infant supports the diagnosis of congenital tuberculosis.
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Inda L, Pérez M, Taicz M, Casimir L, Bologna R. Tuberculosis congénita. An Pediatr (Barc) 2013; 79:198-200. [DOI: 10.1016/j.anpedi.2013.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 10/27/2022] Open
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Abramowsky CR, Gutman J, Hilinski JA. Mycobacterium tuberculosis Infection of the placenta: a study of the early (innate) inflammatory response in two cases. Pediatr Dev Pathol 2012; 15:132-6. [PMID: 22260536 PMCID: PMC4393328 DOI: 10.2350/11-05-1039-cc.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infections with Mycobacterium tuberculosis (MTb) are globally prevalent in many countries, yet descriptions of placental pathology in tuberculous patients are scanty. The usual necrotizing granulomatous response associated with tuberculous infections requires an activation of the adaptive immune system. However, before this system is turned on, the 1st encounter with the tubercle bacillus is mediated by the innate immune system. This pathway utilizes innate surface receptors in neutrophils and histiocytes predominantly and does not produce a granulomatous pattern of inflammation. In this report we describe 2 cases of placental involvement with MTb in which an acute abscess-like inflammatory response with Myeloperoxidase and CD68-positive neutrophils and histiocytes causing acute villitis and intervillitis, with abundant acid-fast mycobacteria, were identified. Other cellular markers consistent with adaptive immunity were negative. These nongranulomatous lesions are seen in primary tuberculous infections occurring in a naïve woman and, obviously, a naïve fetus. These cases with early response inflammation in the placenta are frequently missed precisely because the mother is not known to be infected or has been recently diagnosed and because the symptoms in the newborn may not develop for several weeks, by which time the placenta may have been discarded. This report also shows that the differential diagnosis of acute villitis and intervillitis in the placenta should include tuberculosis aside from the more common bacterial infections such as listeriosis.
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Affiliation(s)
- Carlos R. Abramowsky
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA,Corresponding author,
| | - Julie Gutman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph A. Hilinski
- Children's Healthcare of Atlanta at Egleston Hospital, 1405 Clifton Road, Atlanta, GA 30322, USA
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12
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Dempers J, Sens MA, Wadee SA, Kinney HC, Odendaal HJ, Wright CA. Progressive primary pulmonary tuberculosis presenting as the sudden unexpected death in infancy: a case report. Forensic Sci Int 2010; 206:e27-30. [PMID: 20705406 DOI: 10.1016/j.forsciint.2010.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 07/08/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
The classification of an unexpected infant death as the sudden infant death syndrome (SIDS) depends upon a complete autopsy and death scene investigation to exclude known causes of death. Here we report the death of a 4-month-old infant in a tuberculosis endemic area that presented as a sudden unexpected death in infancy (SUDI) with no apparent explanation based on the death scene characteristics. The autopsy, however, revealed progressive primary pulmonary tuberculosis with intrathoracicadenopathy, compression of the tracheobronchial tree and miliary lesions in the liver. This case underscores the clinical difficulties in the diagnosis of infantile tuberculosis, as well as the possibility of sudden death as part of its protean manifestations. The pathology and clinical progression of tuberculosis in infants differ from older children and adults due to the immature immune response in infants. This case dramatically highlights the need for complete autopsies in all sudden and unexpected infant deaths, as well as the public health issues in a sentinel infant tuberculosis diagnosis.
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Affiliation(s)
- Johan Dempers
- Division of Forensic Medicine and Pathology, Department of Pathology and Western Cape Forensic Pathology Services, Faculty of Health Science, Stellenbosch University, Tygerberg, South Africa.
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13
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Abstract
PURPOSE The diagnosis and treatment of congenital tuberculosis are discussed. SUMMARY Congenital tuberculosis is rare and fatal if left untreated. If a pregnant woman with tuberculosis is not treated, infection of the fetus can occur by hematogenous spread through the umbilical cord or by aspiration or ingestion of amniotic fluid. Signs and symptoms of congenital tuberculosis may be nonspecific, which may preclude early diagnosis and treatment. Criteria for the diagnosis of congenital tuberculosis require the infant to have a tuberculous lesion, as indicated by chest radiography or granulomas, and at least one of the following should be confirmed: (1) onset during the first week of life, (2) primary hepatic tuberculosis complex or caseating hepatic granulomas, (3) infection of the placenta or maternal genital tract, or (4) exclusion of postnatal transmission by a contact investigation. Since 2001, 21 cases of congenital tuberculosis have been reported in English-language medical journals, with the age of presentation ranging from day 1 to 90. Based on findings from published case reports, congenital tuberculosis should be considered in the differential diagnosis of newborns who have (1) nonresponsive, worsening pneumonia, especially in regions with high rates of tuberculosis, (2) nonspecific symptoms but have a mother diagnosed with tuberculosis, (3) high lymphocyte counts in the cerebrospinal fluid without an identified bacterial pathogen, or (4) fever and hepatosplenomegaly. Once diagnosed, it is essential to promptly begin treatment with isoniazid, rifampin, pyrazinamide, and streptomycin in order to decrease the mortality associated with the infection. CONCLUSION Early diagnosis and treatment during the neonatal period are crucial in minimizing the fatality associated with congenital tuberculosis.
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Affiliation(s)
- Sonal Patel
- Drug Information Service, Hoffmann-La Roche Laboratories, Nutley, NJ, USA
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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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de Steenwinkel JEM, Driessen GJA, Kamphorst-Roemer MH, Zeegers AGM, Ott A, van Westreenen M. Tuberculosis mimicking ileocecal intussusception in a 5-month-old girl. Pediatrics 2008; 121:e1434-7. [PMID: 18450886 DOI: 10.1542/peds.2007-1750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 5-month-old girl was diagnosed with tuberculosis, mimicking ileocecal intussusception. The mother of the patient was later diagnosed with renal tuberculosis attributable to the same (unique) Mycobacterium tuberculosis strain. Possibly, that transmission occurred by aspiration or ingestion of infected amniotic fluid or urine, which could occur before or during birth. This case illustrates that tuberculosis can mimic other common diseases and, therefore, can be a difficult diagnosis to make. Because respiratory infection was very unlikely in this case, congenital tuberculosis or postnatal infection via infected urine or breast milk should be in the differential diagnosis. In this article, we focus on different (nonrespiratory) transmission routes of Mycobacterium tuberculosis and give a short review of the recent literature on congenital tuberculosis.
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Affiliation(s)
- Jurriaan E M de Steenwinkel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, s-Gravendijkwal 230 (Room L327), 3015 CE Rotterdam, The Netherlands.
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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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18
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Abstract
With the overall increase in international travel, there is likely to be an increase in travel during pregnancy as well. In developing countries, pregnant women face exposures that can add significant risk for neonatal morbidity and mortality. Infections that can occur in utero or in the early neonatal period include malaria, yellow fever, tuberculosis, hepatitis, human immunodeficiency virus, leishmaniasis, toxoplasmosis, filariasis, Japanese encephalitis, rubella, typhoid fever, leptospirosis, dengue fever, Helicobacter pylori, and trypanosomiasis. When travel and potential exposure cannot be avoided, preventive measures are usually effective. Pretravel consultation should include careful discussion of length of travel, antimalarial prophylaxis, insect avoidance, food and water hygiene, vaccination, and body fluid precautions.
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Affiliation(s)
- Lauren M McGovern
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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19
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Connell T, Bar-Zeev N, Curtis N. Early detection of perinatal tuberculosis using a whole blood interferon-gamma release assay. Clin Infect Dis 2006; 42:e82-5. [PMID: 16652300 DOI: 10.1086/503910] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 02/10/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The diagnosis of perinatal tuberculosis (TB) is problematic because of its nonspecific presentation, the difficulty of obtaining microbiological confirmation, and the unreliability of the tuberculin skin test. Immunodiagnosis of TB has received new attention with the discovery of Mycobacterium tuberculosis-specific immunodominant antigens (early secreted antigenic target 6 [ESAT-6] and culture filtrate protein 10 [CFP-10]) that are encoded by the RD1 region of the pathogen. A whole blood assay has recently been developed to quantitatively measure interferon- gamma production by lymphocytes specific to these antigens, but its evaluation in the diagnosis of TB in infants and children has been limited to date. METHODS In addition to routine diagnostic evaluation (tuberculin skin tests, culture of early-morning gastric aspirate samples, and chest radiographs), 2 infants with suspected perinatal TB were investigated with a whole blood interferon-gamma release assay. RESULTS The results of the tuberculin skin tests were negative for both patients. The findings of the chest radiographs were abnormal with features suggestive of miliary TB. A whole blood interferon- gamma release assay was performed and yielded positive results within 48 h after admission to the hospital for both patients, prompting early antituberculous treatment. M. tuberculosis was cultured after 6 weeks from gastric aspirate samples collected on admission to the hospital from both infants. At 6 months of age, both infants were thriving and had acheived normal developmental milestones. CONCLUSIONS The advent of interferon- gamma release assays may prove to be useful in the evaluation of infants with suspected perinatal TB.
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Affiliation(s)
- Tom Connell
- Infectious Diseases Unit, Department of General Medicine, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, Australia
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20
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Choudhary J, Mubarik M, Parvez A, Naikoo MA. Cavitatory pulmonary tuberculosis in a 52-day-old infant. J R Soc Med 2004. [PMID: 14996964 DOI: 10.1258/jrsm.97.3.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- J Choudhary
- Department of Paediatrics, Government Medical College, Srinagar-190001, Kashmir, India
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Choudhary J, Mubarik M, Parvez A, Naikoo MA. Cavitatory Pulmonary Tuberculosis in a 52-Day-Old Infant. Med Chir Trans 2004; 97:131. [PMID: 14996964 PMCID: PMC1079327 DOI: 10.1177/014107680409700312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J Choudhary
- Department of Paediatrics, Government Medical College, Srinagar-190001, Kashmir, India
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Abstract
We report a case of congenital tuberculosis with an unusual presentation as progressive liver dysfunction, in the absence of respiratory symptoms. Several uncommon features were present, including petechiae, cutaneous lesions, ascites and positive peritoneal fluid culture.
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Affiliation(s)
- David R Berk
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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