ABSTRACT
Objective:To study the clinical characteristics of congenital tuberculosis (CTB).Methods:From June 2016 to February 2021, the clinical data of infants with CTB admitted to the neonatal department of our hospital were retrospectively analyzed, including their clinical characteristics, diagnosis, treatment and prognosis.Results:A total of 7 infants with CTB were enrolled into the study. 4 mothers had in vitro fertilization embryo transfer (IVF-ET) due to tubal obstruction and 2 mothers who were diagnosed of tubal tuberculosis. The 7 infants included 1 male and 6 female, 6 preterm and 1 full-term. The median age of onset was 18 d (7~30 d).All of the 7 infants had fever, 6 had shortness of breath and poor response, 5 had apnea, 3 were coughing, 1 showed pale skin colour, 1 had bilateral rales in the lung, 6 had hepatomegaly, 3 splenomegaly and 1 lymphadenopathy. Chest X-ray showed patchy exudation in 3 infants, miliary pattern of opacification in 2 infants, patchy opacification in 1 infant, bilateral increased lung markings in 1 infant. The positive rate of acid-fast bacilli (AFB) was 50% in all sputum samples. Specimens from glottic and subglottic area showed higher positive rate than oropharyngeal specimen. PCR MTB-DNA tests of sputum samples were positive in all 7 cases. 1 infant received invasive respiratory support for 1 d and died after discharge. 2 infants improved significantly after initial treatment, received 1~2 months of anti-TB therapy outside the hospital and died of severe respiratory failure. Of the 4 infants survived, 1 was cured and 3 significantly improved.Conclusions:Mothers with tubal tuberculosis receiving IVF-ET may cause high risk of CTB. Sputum AFB test and sputum PCR MTB-DNA test are preferred diagnostic tests. Genetic test of drug-resistant TB may guide clinical drug use. Glottic or deeper throat specimens can increase the positive rate.
ABSTRACT
Congenital tuberculosis is a tuberculosis disease caused by the fetus infected with Mycobacterium tuberculosis in the womb or during delivery, which is a kind of special and rare tuberculosis in children.The clinical manifestation of congenital tuberculosis is lack of specificity, difficulty in early diagnosis, rapid progress, easy misdiagnosis and high mortality.At present, there are few studies on congenital tuberculosis.In this review, we will discuss the epidemiology and clinical features of congenital tuberculosis.Importantly, we will further introduce the rapid etiological detection and treatment to strengthen clinicians′ understanding of congenital tuberculosis.
ABSTRACT
TB remains a leading cause of morbidity and mortality in developing countries. The incidence of congenital TB is underestimated. Current recommendations regarding the management of neonates of mothers with tuberculosis are variable and no tangible guidelines have been advised. Congenital TB is fatal if untreated, moreover the mortality and morbidity is increased if the diagnosis and treatment is delayed. Therefore, the treating clinician should be aware of the unusual presentation of congenital TB. A high suspicion and good screening of mothers and neonates is of paramount importance. Congenital tuberculosis is diagnosed by Cantwell criteria. Isoniazid prophylaxis for 6 months is recommended in neonates born to mothers with TB who are infectious. Breastfeeding should be continued, and isolation is recommended only in certain circumstances such as mother is infectious, has multidrug resistant tuberculosis or non-adherent to treatment. BCG vaccine is recommended in all neonates however, the timing of administration varies according to various guidelines. Neonate diagnosed with congenital TB should be treated with anti-tubercular drug regimen.
ABSTRACT
La tuberculosis congénita es una enfermedad de baja ocurrencia, pero con alta morbimortalidad debido a que suele presentar signos inespecíficos, catalogándose a menudo solo como una sepsis neonatal. El diagnóstico correcto suele hacerse por los antecedentes maternos de síntomas graves en la gestación o de formas paucibacilares que se hacen reconocibles en el puerperio, incluyendo la ocurrencia de endometritis y síntomas pulmonares; también se identifica por las pruebas microbiológicas (baciloscopia, cultivos, pruebas genéticas). Radiográficamente el patrón más común es el miliar. En los laboratorios de sangre suele haber biomarcadores inflamatorios elevados, trombocitopenia y pruebas hepáticas anormales. El tratamiento farmacológico suele ser exitoso. Se presenta un caso de una recién nacida, hija de una madre paucibacilar, que fue tratada inicialmente como sepsis neonatal y mejoró luego de la terapia antituberculosa.
Congenital tuberculosis is a disease of low occurrence, but with high morbidity and mortality due to the nonspecific signs usually present but that are often classified only as a neonatal sepsis. A correct diagnosis is made by maternal history of severe symptoms during pregnancy or paucibacillary forms that become recognizable in the postpartum period, including the occurrence of endometritis and pulmonary symptoms. It is also identified by microbiological tests (baciloscopy, cultures, genetic assays). Radiographically, the most common pattern is of miliary lesions. In blood tests, elevated inflammatory biomarkers, thrombocytopenia and abnormal liver tests are found. Drug treatment is usually successful. We present a case of a female baby born from a paucibacillary mother, it was handled first as neonatal sepsis, and her improvement after antituberculous therapy.
Subject(s)
Humans , Tuberculosis/congenital , Infant, Newborn , SepsisABSTRACT
Congenital tuberculosis (TB) is a rare disease that is associated with high mortality. Mycobacterium tuberculosis, the causative agent, may be transmitted from the infected mother to the fetus by the transplacental route or by aspiration of infected amniotic fluid. Clinical symptoms and signs are not specific. Miliary patterns are the most common findings in the chest X-rays of many infants with congenital TB. In this case, an 18-day-old boy had jaundice on the fifth day of birth, and fever and respiratory distress appeared on the 18th day. Chest X-ray showed diffuse fine bilateral infiltration. Clinically, pneumonia or sepsis was suspected. Respiratory symptoms and chest X-ray findings worsened despite empirical antibiotic therapy. The lungs showed miliary infiltration suggestive of TB. Gastric aspirates were positive for M. tuberculosis. Respiratory distress and fever were gradually improved after anti-TB medication. Congenital TB is difficult to detect because of minimal or no symptoms during pregnancy and nonspecific symptoms in neonates. Hence, clinicians should suspect the possibility of TB infection even if neonates have non-specific symptoms. Early diagnosis and meticulous treatment are required for the survival of neonates with TB.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Pregnancy , Amniotic Fluid , Early Diagnosis , Fetus , Fever , Jaundice , Lung , Mortality , Mothers , Mycobacterium tuberculosis , Parturition , Pneumonia , Rare Diseases , Sepsis , Thorax , Tuberculosis , Tuberculosis, MiliaryABSTRACT
La tuberculosis congènita es una enfermedad rara, con alta tasa de mortalidad. Es considerada el resultado de la transmisión vertical de la infección desde la placenta al feto, a través de la aspiración de líquido amniótico o por vía transplacentaria a través de las venas umbilicales. El diagnóstico de la enfermedad suele ser difícil porque los signos clínicos son inespecíficos. Se presenta el caso de un lactante varón de 48 días de vida, que fue internado por pérdida de peso, fiebre, tos, hemoptisis y dificultad respiratoria durante los últimos 20 días. Había recibido antibióticos de amplio espectro durante ese lapso, sin presentar mejoría. La radiografía de tórax mostró una consolidación con una lesión cavitaria en los campos medio y superior izquierdo. Se detectó Mycobacterium tuberculosis por reacción en cadena de la polimerasa en una muestra tomada por lavado broncoalveolar y, con ese hallazgo, se diagnosticó tuberculosis congènita. Se comenzó, entonces, el tratamiento con tuberculostáticos. El paciente falleció al 13er día de tratamiento. En lactantes con pérdida de peso, fiebre, tos, hemoptisis y dificultad respiratoria, debiera considerarse la posibilidad de tuberculosis congénita.
Congenital tuberculosis is a rare disease with a high mortality rate. Congenital tuberculosis is considered the result of mother-to-child transmission from the placenta to the fetus, through the ingestion of the amniotic fluid, or via transplacental transmission through the umbilical vein. Given the non-specific clinical signs of tuberculosis, it is usually difficult to diagnose it. The case of a 48-day-old male infant hospitalized due to weight loss, fever, cough, hemoptysis, and respiratory distress for the past 20 days, is presented. In this period, he had received broad spectrum antibiotics but with no improvement. A chest x-ray showed the presence of consolidation and a cavitary lesion in the upper and middle left lung fields. Mycobacterium tuberculosis was detected by polymerase chain reaction in a bronchoalveolar lavage specimen. Congenital tuberculosis was diagnosed based on this finding; hence, a tuberculostatic regimen was started accordingly. The patient died 13 days after treatment initiation. Congenital tuberculosis should be considered in infants with weight loss, fever, cough, hemoptysis and respiratory distress.
Subject(s)
Humans , Male , Infant, Newborn , Tuberculosis/congenital , Infant, Newborn , MortalityABSTRACT
La tuberculosis congénita es una forma clínica infrecuente de presentación de la enfermedad, de difícil diagnostico por la falta de especificidad de las manifestaciones clínicas. Revisamos las formas de prevención, diagnóstico y tratamiento de la enfermedad.
Congenital tuberculosis is an infrequent form of presentation of the disease, of difficult diagnosis for the lack of specificity of the clinical manifestations. We review the forms of prevention, diagnosis and treatment of the disease.
ABSTRACT
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.
ABSTRACT
Congenital tuberculosis is an unusual and severe clinical presentation of Mycobacterium tuberculosis (MTB) infection. It is usually difficult to diagnose and treat. We report a tenweek- old male infant who had presented with fever, difficulty in breathing, abdominal distension, convulsion, low weight gain since one month of his age. The diagnosis was made by demonstration of MTB bacilli in the gastric aspirate of baby and chest radiography. Treatment with the four drug regimen including streptomycin was initiated, but the baby died on the third day of ATT. This case gives an account of difficulties in diagnosis and therapeutic management of congenital tuberculosis and alerts for development of protocols that foresee these difficulties.
ABSTRACT
Congenital tuberculosis is a rare disease in which an unborn child inside the uterus or right after delivery is infected with tubercle bacillus, due to the mother suffering primary tuberculosis right before pregnancy or during pregnancy. As a newborn who was naturally delivered with a gestational age of 38 weeks, and 3.02 kg in birth weight, he entered an other hospital with a fever, which he contracted one month after birth, but the fever continued for 10 days, thus he was transferred to this hospital. Chest radiography, indicated infiltration of both lungs, thus he was treated with suspected pneumonia and sepsis. And then, his symptoms became favorable, and he left hospital. However, since chest radiography one month later, his condition had not improved, thus he was hospitalized again. In a computerized chest tomography scan, infiltration of the lungs and tuberculosis were suspected due to a mysterious region of shadow. A tubercle bacillus test was conducted, and the tuberculin test was negative. However, acid- fast bacilli smear, acid-fast bacilli culture test, and polymerase chain reaction test, which were carried out the gastric aspiration were positive. The patient was administered antitubercular agents under the diagnosis of congenital tuberculosis, and he is currently under observation as an outpatient, without complications. The authors experienced a case of congenital tuberculosis, which was discovered due to fever, generated 4 weeks after birth, and to abnormal views in chest radiography, which continued more than 2 months. We report this.
Subject(s)
Child , Humans , Infant , Infant, Newborn , Pregnancy , Antitubercular Agents , Bacillus , Birth Weight , Diagnosis , Fever , Gestational Age , Lung , Mothers , Outpatients , Parturition , Pneumonia , Polymerase Chain Reaction , Radiography , Rare Diseases , Sepsis , Thorax , Tuberculin Test , Tuberculosis , UterusABSTRACT
Perinatal tuberculosis can be divided into congenital tuberculosis due to intrauterine infection and neonatal tuberculosis due to infection irnmediately following birth. It is a rare disease entity with only 300 cases reported worldwide. In Korea, only a few cases have been reported and only 1 case has been confirmed by autopsy at neonatal period. Although the majority of the mothers are found to have advanced tuberculosis and the children themselves are usually of premature birth, early diagnosis is difficult and despite antituberculous medication, the mortality rate is high. We report a premature baby with respiratory difficulty admitted to our hospital, whose mother was found to have miliary tuberculosis during the course of management. The baby died and autopsy was performed to confirm congenital tuberculosis.
Subject(s)
Child , Humans , Autopsy , Early Diagnosis , Korea , Mortality , Mothers , Parturition , Premature Birth , Rare Diseases , Tuberculosis , Tuberculosis, MiliaryABSTRACT
Congenital tuberculosis is a rare disease and it is difficult to diagnose because of the nonspecific nature of the presenting symptoms, signs and the fatal outcome in the absence of early therapy. We experienced a case of congenital tuberculosis in a newborn infant, who was born prematurely to a mother who had a miliary pulmonary tuberculosis confirmed on the 34th postpartum days. At the age of 32 days, chest X-ray revealed total hazziness of the right lung and the infant required intubation and mechanical ventilation. At that time a significant number of fungi were found in the urine culture. Amphotericin B therapy was started with the impression of fungal pneumonia. DIC developed despite of intensive therapy. Based on the medical history of the mother, laboratory tests were done on the infant for the isolation of M. tuberculosis at the age of 34 days. Acid-fast bacilli were seen in the gastric aspirates and sputum by staining and antituberculosis therapy with isoniazid, rifampin, pyrazinamide and prednisolone was started. Significant clinical improvement occurred 2 weeks after therapy began.
Subject(s)
Humans , Infant , Infant, Newborn , Amphotericin B , Dacarbazine , Fatal Outcome , Fungi , Intubation , Isoniazid , Lung , Mothers , Pneumonia , Postpartum Period , Prednisolone , Pyrazinamide , Rare Diseases , Respiration, Artificial , Rifampin , Secondary Prevention , Sputum , Thorax , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
We experienced a case of congenital tuberculosis infected in utero, who had been found to have massive ascites and pleural effusion on routine ultrasonography at the 39 weeks' gestation. The emergency C-section delivered a male neonate weighing 2,050 g with poor condition and in severe respiratory distress. He was the first child born of a 27-year-old woman, who was diagnosed as having tuberculous pleurisy after delivery. Detection of acidfast bacilli in gastric aspirates obtained from the newborn as well as the clinical features and maternal history confirmed the diagnosis of congenital tuberculosis. Though rare, congenital tuberculosis requires early detection and treatment because of its severity and high mortality. A brief review of the relevant literature was made.