A pre-term infant of 32 weeks gestation with congenital tuberculosis treated successfully with antituberculosis chemotherapy

An infant of 32 weeks gestation was separated from her mother at birth for treatment of hyaline membrane disease and, on recovery, was cared for by adoptive parents. At 25 days, she was treated for pneumonia with immunoglobulins and multiple antibiotics and appeared to respond. Her symptoms recurred at 8 weeks and tuberculosis was confirmed by detection in an acid-fast bacilli smear of gastric aspirate. Her mother presented with disseminated tuberculosis with meningitis 1 month after delivery. Criteria for the diagnosis of congenital tuberculosis in the infant were confirmed.

Congenital TB associated with asymptomatic maternal endometrial TB

Congenital TB has varied clinical manifestations, and may mimic septicaemia in neonates. Congenital TB is transmitted through the infected placenta via the umbilical vein or inhalation and ingestion of infected amniotic fluid. Endometrial TB usually manifests as infertility; however, congenital TB can be identified in the presence of asymptomatic maternal endometrial TB. We report a case of congenital TB associated with asymptomatic maternal endometrial TB to highlight the need for endometrial biopsy in such cases.

Management of newborn infant born to mother suffering from tuberculosis: current recommendations & gaps in knowledge

Tuberculosis (TB) is a global disease with increase in concern with growing morbidity and mortality after drug resistance and co-infection with HIV. Mother to neonatal transmission of disease is well known. Current recommendations regarding management of newborns of mothers with tuberculosis are variable in different countries and have large gaps in the knowledge and practices. We compare and summarize here current recommendations on management of infants born to mothers with tuberculosis. Congenital tuberculosis is diagnosed by Cantwell criteria and treatment includes three or four anti-tubercular drug regimen. Prophylaxis with isoniazid (3-6 months) is recommended in neonates born to mother with TB who are infectious. Breastfeeding should be continued in these neonates and isolation is recommended only till mother is infectious, has multidrug resistant tuberculosis or non adherent to treatment. BCG vaccine is recommended at birth or after completion of prophylaxis (3-6 months) in all neonates.

Congenital tuberculosis: a rare manifestation of a common disease

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.

Congenital tuberculosis and management of exposure in three neonatal intensive care units

Congenital tuberculosis (TB) is uncommon, and diagnosis may be delayed. We report a case of congenital TB and the management of exposure in three different neonatal intensive care units. This case demonstrates the need for a high index of suspicion, active communication among maternal and neonatal medical providers, and timely provider reporting of maternal disease, and emphasizes the relatively greater risk of transmission to health care workers versus infants in this setting.

[The newborn infant of a mother with tuberculosis]

TBC is a major infectious emergency in the world. OMS suggest that there are 8 millions of affected every year and 2 millions of deaths. Italy is considered a country with low prevalence, but the increase of the immigration from Africa Asia and Est Europa (country with high risk) imposes attention to the problem. The delivery is a critical moment to investigate people at risk of disease. The infection of the newborn can happen intrauterine or in the expulsive period, but is possible also at home, from somebody affected by an active pulmonary disease. Diagnosis in the newborn is not easy for the aspecificity of clinical signs and for the frequent initial negativeness of Mantoux test. Culture of placenta, gastric aspirate, tracheal secretions, urine would be requested, cerebrospinal fluid if necessary. Neonatal disease needs therapy with isoniazide, rifampicine, pirazinamide and, or ethambutol, or streptomycin. Profilaxis of a newborn from a woman affected by an active form of tuberculosis or living with people affected by an active pulmonary form consists in giving isoniazide until diagnostic tests are negative and in removing the sicks (only with pulmonary disease). New dangerous kinds of pharmacological multiresistent tuberculosis are appeared in the last years in the world and, with the coinfection HIV-TBC and the reorganization of the surveillance system, represents the major obligation for the next years.

Congenital tuberculosis: late manifestation of the maternal infection

Tuberculosis in pregnancy though not uncommon, congenital tuberculosis continues to be a rare entity. A case of congenital tuberculosis where the mother manifested the disease 3 months after it was diagnosed in the newborn is reported considering its rarity.

[Management of asymptomatic newborns with periportal hypodensity and high serum IgM who were born from untreated tuberculosis mothers]

OBJECTIVES

We previously reported the presence of periportal hypodensity on CT image in two newborns and an early infant with congenital tuberculosis as an adjunct diagnostic option. The aim of this study was to determine the degree of treatment based on both periportal hypodensity and serum IgM presented in asymptomatic newborns born from tuberculosis mothers.

SUBJECTS AND METHODS

Eight newborns born from mothers with untreated tuberculosis between 1996 and 2002 were retrospectively studied. Newborns who presented periportal hypodensity and high serum IgM were treated with anti-tuberculosis medicines, combination of isoniazid and rifampicin for nine to 12 months with streptomycin in the initial two months, and the outcomes of the treatment were followed for at least two years.

RESULTS

All eight newborns had gastric aspirates negative for Mycobacterium tuberculosis. Three of eight newborns (38%) demonstrated periportal hypodensity, and they also demonstrate a tendency of high serum IgM. None of these three newborns treated with combination of isoniazid, rifampin, and streptomycin for 9 to 12 months developed tuberculosis during the observation period.

CONCLUSIONS

These results suggest that presence of both periportal hypodensity and high serum IgM in asymptomatic newborns born from mothers with untreated tuberculosis may be one of risk factors of developing congenital tuberculosis, and that anti-tuberculosis treatment for nine to 12 months may prevent them from the disease development despite possible criticism of overdiagnosis and overtreatment.

[An infant with tuberculosis who previously contacted an infant with congenital tuberculosis]

We report a case of one-year and three-month old male infant with healed tuberculosis who was found by positive tuberculin skin test prior to scheduled BCG vaccination. Abdominal CT imaging revealed calcification in liver, spleen, and lymphnodes along pancreas and hepato-duodenal ligament, despite of normal chest imaging. A temporary intubated infant with congenital tuberculosis and/or his mother with untreated tuberculosis might infect him during his stay in the same NICU when he had digestive disease at three-month old. This report suggests that periodic contact investigation is needed for infants who had contact with the intubated infant with congenital tuberculosis in the same room, since cell-mediated immunity is not well developed in infants.

[CT imaging findings in congenital tuberculosis, Part I: Usefulness of periportal hypodensity in the diagnosis of congenital tuberculosis]

We treated three newborns and early infants with congenital tuberculosis between 1996 and 2001. We reported imaging presentations of the three cases born in and after 1996 when new CT equipment (CT-HAS-SGS, GE-Yokokawa, Tokyo) was introduced in our institute. These three cases of congenital tuberculosis showed periportal hypodensity, in addition to pulmonary infiltrate, mediastinal and abdominal lymphadenopathy on CT images. Early diagnosis of congenital tuberculosis is urgently needed, however, it is very difficult. Our findings suggested that clinical suspicion supplemented by careful imaging examinations may facilitate the early diagnosis of congenital tuberculosis, and the detection of periportal hypodensity may offer a new additive diagnostic option to congenital tuberculosis.

Congenital tuberculosis presenting as sepsis syndrome

A 20 day old male infant presented with fever, respiratory distress and poor feeding for 7 days. He was referred from a community hospital and diagnosed as sepsis. Physical examination revealed hepatosplenomegaly. A chest radiograph showed miliary infiltration of both lungs. Smear of gastric washing for AFB was positive. Congenital tuberculosis was diagnosed, the infant was successfully treated with antituberculous drugs and followed up monthly for 1 year. He had good health and normal development after the illness.

Congenital tuberculosis presenting as progressive liver dysfunction

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.

[Tuberculosis in the newborn: recrudescence in areas with high endemic HIV infection]

Despite the rising prevalence of tuberculosis due in part to the HIV pandemic in Africa, there have been few reports describing neonatal or congenital tuberculosis and its association with maternal HIV infection has been rare. The purpose of this study was to evaluate the clinical and epidemiological features of tuberculosis in newborns from areas with high endemic rates of both tuberculosis and HIV infection. During the 2-year study period all neonates admitted to the Campus Teaching Hospital in Lomé, Togo for differential diagnosis of symptoms compatible with tuberculosis were investigated. The clinical profile of tuberculosis in the newborn was correlated with that of the mother with or without HIV infection. Perinatal tuberculosis was diagnosed in 13 of the 79 newborns investigated including 8 whose mothers were co-infected by HIV and tuberculosis. Seven cases were classified as congenital tuberculosis. The predominant clinical features were respiratory distress (10/13), fever (9/13), hepatomegaly (9/13), intra-uterine growth retardation (8/13), stagnation or loss of weight (6/13), cough (4/13) and splenomegaly (4/13). Diagnosis of maternal HIV and tuberculosis infection was never made prior to newborn admission to our department. Four newborns and two mothers died within 3 months after childbirth. This study on perinatal tuberculosis in children born to mothers with or without HIV infection demonstrates the need for early diagnostic methods, consensual therapeutic protocols, and further study in larger geographical area to specify epidemiologic features and reduce high mortality.

Congenital tuberculosis

This is a retrospective study of congenital tuberculosis in Queen Sirikit National Institute of Child Health from 1979 to 1998. There were 9 patients with a mean birth weight of 2,500 grams (range 1,800-3,300). The onset of symptoms and age of diagnosis ranged from 7 to 42 (mean, 21) days and 14 to 75 (mean, 54) days after birth, respectively. The presenting signs and symptoms were fever (100%), poor feeding (100%), irritability (100%), failure to gain weight (100%), hepatomegaly (100%), splenomegaly (77.8%), cough (88.9%), respiratory distress (66.7%) and abdominal distension (77.8%). The tuberculin skin test reaction with > or = 10 mm induration was found in 2 of 8 patients. Their abnormal chest radiographs revealed bronchopneumonia 66.7 per cent, miliary pattern 33.3 per cent and multiple cystic lesion 11.1 per cent. The bacteriological study from gastric aspirate content for acid-fast bacilli (AFB) staining and culture were positive in 62.5 and 71.4 per cent respectively. Fatality rate was 33.3 per cent with no sequele found in the survivors. Congenital tuberculosis is a rare entity and difficult to give an early diagnosis. There should be a high index of suspicion for tuberculosis in those who had pneumonia and were unresponsive to aggressive antibiotics or had unexplained etiology.

Congenital tuberculosis proven by percutaneous liver biopsy: report of a case

A female term neonate with congenital tuberculosis presented with clinical manifestations of cough, respiratory distress and bilateral reticulonodular infiltration on chest radiograph. Her Indonesian mother had extrapulmonary tuberculosis. The neonate's tuberculosis symptoms were characterized by multi-organ involvement including lung, liver, gall bladder and kidneys, suggesting a spreading hematogenous transmission. Pathology of the liver biopsy revealed scattered miliary granuloma. After anti-tuberculosis treatment, significant improvement was seen on chest radiogram and in her clinical condition. Congenital tuberculosis should be suspected in infants who are unresponsive to empirical antibiotics. Transcutaneous liver biopsy may help confirm its prenatal origin.

Cerebral hemorrhage associated with vitamin K deficiency in congenital tuberculosis treated with isoniazid and rifampin

We report a male infant with congenital tuberculosis who developed cerebral hemorrhage associated with vitamin K deficiency during treatment with isoniazid and rifampin. Despite an absence of risk factors for vitamin K deficiency, the severe hemorrhagic disorder occurred at 4 months of age. We speculate that vitamin K deficiency in the present case may have resulted from a synergic effect of antituberculosis agents and immaturity of vitamin K metabolism and/or its absorption.

Congenital tuberculosis and management of exposures in a neonatal intensive care unit

OBJECTIVES

We report a case of congenital tuberculosis in a neonatal intensive care unit (NICU) and the management of exposure to other neonates in the hospital. We review the literature regarding congenital tuberculosis and management of exposures in the NICU.

DESIGN

Case report and a survey of exposures with a 3-month follow-up.

SETTING

Urban hospital.

PATIENTS

Neonates exposed to a case of congenital tuberculosis.

INTERVENTIONS

Exposure to tuberculosis was treated with isoniazid. Purified protein derivative tests were placed at baseline and 3 to 4 months after exposure. Chest radiographs were performed if clinically indicated.

RESULTS

Congenital tuberculosis was diagnosed in our patient at 21 days of age during a prolonged hospital course. After initiation of anti-tuberculous medications, the patient gradually recovered from his illness. While he was treated in the NICU, there were 37 potentially exposed infants. Of these, 36 were administered tuberculin skin tests (average age, 1.7 months), all of which were read as 0 mm of induration. Of those 37, 35 began prophylaxis with isoniazid, and 30 were able to complete treatment with a minimum of 3 months of isoniazid therapy. Of those 30, two infants received 6 months of therapy. Additionally, 29 of the 37 infants had chest radiographs, none of which showed suspicious infiltrates or adenopathy. Finally, 30 of the 36 infants had repeat tuberculin skin tests at 3 months, all of which were read as 0 mm of induration (average age, 3.7 months).

CONCLUSION

Congenital tuberculosis is an uncommon disease t hat requires early diagnosis for successful therapy and vigilant follow-up of potential exposures in the NICU.

Congenital tuberculosis associated with maternal asymptomatic endometrial tuberculosis

This is a report of a 4-month-old baby girl who presented with respiratory distress, bronchopneumonia, marasmus and hepatosplenomegaly and proved to have congenital tuberculosis on the basis of a strongly positive Mantoux test and liver biopsy findings. Endometrial biopsy in the asymptomatic mother confirmed the source of infection and the perinatal onset of illness. The age range of previously reported cases of congenital tuberculosis is 1-84 days and this case would appear to be the latest presentation of congenital tuberculosis in the literature.

Congenital tuberculosis: a rare manifestation of a common infection

The epidemiology of tuberculosis has changed dramatically over the past 5 years with significant shifts in at-risk populations, resulting in increased disease among young adults and children, especially among those from developing countries. Congenital tuberculosis is rare, and the clinical presentation of tuberculosis during pregnancy and infancy is often non-specific, making recognition difficult. Advances have been made with diagnostic tools, in public health practices, and with treatment recommendations. Controversy and debate continue regarding the safety and use of isoniazid for latent tuberculosis infection during pregnancy. New vaccine development may be promising for the future, but much work is needed to understand the complicated immune response to tuberculosis.

Tuberculosis (presumed congenital) in a neonatal unit in Dar-es-Salaam, Tanzania

This is the first report of congenital tuberculosis from Tanzania. It discusses the problems of diagnosis in a typical neonatal unit in a developing country. Three cases are reported within 1 year. Failure to thrive was the most common symptom. We speculate that congenital tuberculosis is not rare and carries a high mortality. There is need to have a high index of suspicion especially where maternal HIV and tuberculosis are highly prevalent.

Congenital tuberculosis presenting as sepsis syndrome: case report and review of the literature

We report an infant with congenital tuberculosis who presented with fulminant septic shock, disseminated intravascular coagulation and respiratory failure. Aggressive resuscitation and supportive care and prompt initiation of antituberculosis medications led to resolution of the shock state. We reviewed six other cases with a similar presentation. Congenital tuberculosis should be in the differential of the infant presenting acutely with sepsis syndrome.

Connatal tuberculosis in an extremely low birth weight infant: case report and management of exposure to tuberculosis in a neonatal intensive care unit

A case of connatal tuberculosis in an extremely low birth weight infant is reported. The patient was a female with a birth weight of 973 g born in the 27th week of pregnancy. She developed respiratory distress and signs of infection immediately after birth, which did not respond to mechanical ventilation, antibiotics, and corticosteroid therapy. Connatal tuberculosis was confirmed at 48 days of age by isolation of Mycobacterium tuberculosis from the infant's tracheal aspirate and the mother's menstrual discharge. The infant died of respiratory failure at 90 days of age. Mantoux tuberculin skin tests (TST) were performed on 99 infants, 144 medical staff members, and two family members. TST conversion occurred in three medical staff members, and preventive therapy with isoniazid was initiated. Eight exposed infants had normal chest X-rays and negative gastric aspirates for acid-fast bacilli and all received preventive isoniazid therapy. No case of tuberculosis developed during the 2-year follow-up period.

CONCLUSION

Connatal tuberculosis should be considered in neonatal respiratory infection resistant to antibiotics. Prevention of transmission of tuberculosis on the neonatal intensive care unit by chemoprophylaxis is important.

Sonographic diagnosis of congenital tuberculosis: an experience with four cases

Abdominal sonography of four infants with pyrexia and hepatomegaly demonstrated multiple hypoechoeic hepatic and splenic foci, guided biopsies of which showed caseating granulomas with acid-fast bacilli. Evidence of tuberculosis in maternal endometrium and its exclusion in the contacts further confirmed a diagnosis of congenital tuberculosis. Clinical suspicion supplemented by careful sonography facilitated early detection and antemortem diagnosis of this potentially fatal disease.

Congenital tuberculosis

A 29 day old male infant presented with a history of fever, cough, increasing respiratory distress and abdominal distension from the 10th day of life. Examination revealed failure to thrive, marked tachypnea, pallor, hepatosplenomegaly and harsh vesicular breath sounds. Chest skiagram showed extensive broncho-pneumonic changes. As the infant did not respond to antibiotics, he was investigated for tuberculosis. The gastric aspirate smear showed plenty of acid fast bacilli (AFB) and culture showed M. tuberculosis growth. Endometrial biopsy of the mother showed tuberculous granuloma and acid fast bacilli and culture of the aspirate from endometrium grew M. tuberculosis. The need for endometrial biopsy of mothers of infants with congenital tuberculosis is highlighted.

Congenital tuberculosis in a neonatal intensive care unit: case report, epidemiological investigation, and management of exposures

Disseminated tuberculosis was diagnosed at the autopsy of a 65-day-old premature infant who died in a 52-bed neonatal intensive care unit (NICU). Both parents and one sibling had previously had positive tuberculin skin tests (TSTs); none had active pulmonary tuberculosis, but a second sibling had hilar adenopathy. Congenital transmission was confirmed by isolation of Mycobacterium tuberculosis from the mother's endometrium and the infant's lung tissue. Both strains were identical by DNA restriction fragment analysis. TSTs were performed on 14 neonates, 27 NICU visitors, 11 contacts of the family, and 260 health care workers. TST conversion occurred in two nurses (0.8%); both had normal chest radiographs and received isoniazid therapy. Exposed neonates had negative chest radiographs, had negative gastric aspirates for acid-fast bacilli, and received isoniazid preventive therapy. Diagnosis of congenital tuberculosis requires a high index of suspicion. Transmission of tuberculosis in the NICU setting is unusual but can occur.

Congenital and perinatal tuberculosis: discussion of difficult issues in diagnosis and management

Tuberculosis (TB) has become more prevalent in women of childbearing age and, as well, more frequent in their children. This has occurred for a number of reasons, including: (1) women and children who have immigrated to this country from areas where TB is endemic, such as Mexico and Southeast Asia; (2) the development of multidrug-resistant organisms; (3) the increase seen in patients who live in congregate areas who are at higher risk for acquisition of TB; (4) more difficult access to adequate medical care; and (5) increases in adults and children who have become infected with human immunodeficiency virus. The focus of this review is on congenital and perinatally acquired TB including discussion of epidemiology, the stages of TB, the effects of TB infection and disease during pregnancy on the fetus and mother, congenital and perinatal TB, the potential role of the use of BCG vaccine in infants, and the emergence of multidrug-resistant TB on therapy of the pregnant mother and her fetus and the mother and her infant after delivery.

[Pulmonary manifestations of tuberculosis in children]

The occurrence of tuberculosis in children is dependent on a contagious bacillus carrying adult. Among 500 cases notified annually, perhaps 5 or 6% of the total infectious reservoir in France, 75% have parenchymal pulmonary disease and/or lymph nodes. These tuberculous diseases only represent 10% of the pulmonary disorders: 90% remain primary infections (PI active) or latent infections. These are most often asymptomatic (PI Latent) or of low grade activity (PI active). The CT scanner and fibreoptic bronchoscopy are indispensable complementary investigations in tuberculous disease. Whatever the clinical picture the diagnosis rests on bacteriological confirmation (but only 30% of cultures are positive) and most often rests on a body of evidence: for example a contagious adult living in proximity or a contagious family, or other risk factors are present. The evidence of a child with whatever form of pulmonary tuberculosis, even a latent primary infection, requires treatment which is adapted in such a way to enable a cure and to protect against subsequent endogenous re-activation. A coherent system of co-operation between the hospital and community service and between paediatricians and adult physicians is indispensable to find the index adult case to break the chain of contagion. There are two specific aspects in children, first congenital tuberculosis when a diagnosis is difficult and secondly tuberculosis in a child who is HIV positive when the management can be delicate.

[Current concepts on the course of pregnancies complicated by tuberculosis]

Tuberculosis is a public health problem in many countries, in the last ten years it has been a revival of this infection worldwide, including developed countries. Before chemotherapy emergency tuberculosis had a poor prognosis for the pregnancy, evolution change since the use of effective antituberculous drugs. In this moment if a pregnant woman receives a correct treatment, she will not experience an aggravation of the infection, nevertheless tuberculosis may cause an increase of the obstetric and neonatal mortality and morbidity rate, more frequently in women of developing countries or without treatment. Congenital tuberculosis is not frequent but is another risk for the newborns of tuberculous pregnant women.

A female patient with tuberculous polyserositis, and congenital tuberculosis in her new-born child

A 24-year-old woman was admitted to our department with sepsis, polyserositis and suspected abdominal tumor immediately after delivery. Effusion analyses suggested an etiology of tuberculosis. The severe general condition of the patient allowed for no invasive diagnostic procedures. Antituberculosis therapy was administrated too late and was of no benefit. The fatal outcome was due to septic shock and adult respiratory distress syndrome (ARDS). Autopsy findings confirmed tuberculous polyserositis as well as tuberculous infection of the lungs. The same diagnosis was established in her newborn infant, who responded well to antituberculosis treatment.

Isolated congenital tuberculosis otitis in a preterm infant

We report an unusual case of localized congenital tuberculosis otitis in a preterm infant. Unlike disseminated congenital cases, the manifestations of localized otitis are associated with a triad of signs: (i) regional lymphadenopathy in the absence of typical systemic features of tuberculosis; (ii) delayed onset of presentation; and (iii) refractory otitis unresponsive to conventional antimicrobial agents. The need for greater diligence in looking for neonatal tuberculosis is emphasized, especially in an ethnic or socioeconomic environment where the disease is prevalent.

Neonatal tuberculosis

We present an autopsy case of neonatal miliary tuberculosis in a 36-day-old baby that was born to a mother who had no symptoms. Histopathological examination of lungs revealed necrosis and numerous acid-fast bacilli. Mycobacterium tuberculosis hominis was isolated by guinea pig inoculation with lung tissue. Three months after dietary the mother was admitted with pleural effusion and endometrial biopsy showed a granulomatous inflammation compatible with tuberculosis. Intrauterine infection was considered and that was supported by retrospective findings of the endometrial biopsy. We also want to emphasize the importance of searching for genital tuberculosis even if the mother has no symptoms.

Congenital tuberculosis

A neonate presented with poor feeding, jaundice and hepatosplenomegaly. He was in liver failure with disseminated coagulopathy. Post-mortem liver biopsy revealed discrete granulomas with central necrosis and acid-fast bacilli on Ziehl-Nielsen's stain. The mother had active tuberculosis at delivery. The principal characteristics of congenital tuberculosis are reemphasized in this observation.