The presence of caseating hepatic granulomas permits congenital and postnatally acquired tuberculosis to be distinguished on the basis of liver-biopsy findings alone. 1994;330(15):1051–1054. Repeat chest and abdomen CT imaging performed when the infant was 24 days old indicated patchy consolidation in the right upper lung, multiple new nodules in both the lungs, moderate pleural effusion, and multiple low-density nodules in the spleen and hepatic hilar region without hepatomegaly (Figures 1C,D). The most common chest imaging findings were pneumonia, multiple pulmonary nodules, and miliary pattern. Nat Rev Microbiol. Our patient was a neonate with congenital TB with rare presentations. 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The repeat C-reactive protein level was elevated to 14.4 mg/dL. (2017) 96:e7562. Antituberculous therapy should be commenced on suspicion or while awaiting bacteriological confirmation. We describe two patients with congenital tuberculosis. Ann Trop Paediatr. The M. tuberculosis isolates from the infant, the grandmother, and the mother were sensitive to all antituberculous medications and had the same pattern of restriction-fragment-length polymorphism. Visitation of the hospitalized pediatric patient should be restricted to adults in whom contagious tuberculosis has been excluded. SL treated and diagnosed the patient, also drafted, reviewed, and revised the manuscript, and approved the final manuscript as submitted. Many authors have inferred that infection of the placenta or the maternal genital tract is necessary for congenital transmission1-5,9. Myers JP, Perlstein PH, Light IJ, Towbin RB, Dincsoy HP, Dincsoy MY. Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. (2014) 3:41–3. The demonstration of a primary hepatic complex requires an open surgical procedure or autopsy to confirm liver and regional lymph-node involvement9. Women who are TST positive should undergo evaluation for active disease. ), Centers for Disease Control and Prevention, Atlanta; the Department of Pediatrics and the Steele Memorial Children's Research Center, University of Arizona, Tucson (Z.M.S. Symptoms of hematogenous congenital tuberculosis can be present at birth but more commonly appear by the second or third week of life.105,106 The most common manifestations are respiratory distress, fever, hepatosplenomegaly, poor feeding, lethargy or irritability, lymphadenopathy, abdominal distention, ear drainage, and skin lesions. Hematogenous dissemination of Mycobacterium tuberculosis may occur after rupture of a placental tubercle in the fetal circulation, leading to a primary hepatic complex. Because of the difficulty in ascribing the precise mode of transmission, some researchers suggest that the term perinatal tuberculosis be used to describe the acquisition of tuberculosis before or shortly after birth (Lackmann, 1994). Am J Dis Child 1951;81:471-482. His family denied that the neonate's mother had TB contact history. Diagnosis by direct acid-fast smears from middle-ear fluid, bone marrow, tracheal aspirate, or tissue biopsy are useful and should be attempted.105 Examination and culture of CSF should be performed, although the yield of such tests is low because only 20% of affected children have meningeal involvement. Exposed infants, visitors, and health care workers should undergo evaluation for tuberculosis infection or disease. Inhalation of M. tuberculosis by women results in four possible outcomes, namely the immediate clearing of the organism, latent infection, onset of an active disease, or onset of an active disease years later. Impact Factor 2.634 | CiteScore 2.6More on impact ›, Cambridge University Hospitals NHS Foundation Trust, United Kingdom, South Tees Hospitals NHS Foundation Trust, United Kingdom. Corner BD, Brown NJ. Women of childbearing age who have HIV infection may therefore be at increased risk for placental or genital tuberculosis, resulting in an increased risk of congenital transmission. 2nd ed. Tuberculosis in patients with human immunodeficiency virus infection. Congenital tuberculosis is rare, with fewer than 400 cases reported in the English language literature.105 The affected infant's mother can have tuberculous pleuritis, meningitis, genital tract infection or disseminated disease during pregnancy, but in some series of congenital tuberculosis, diagnosis of tuberculosis was made in the mother at or after delivery in <50% of cases.106 Occurrence and intensity of hematogenous dissemination during pregnancy determine congenital infection. The mother should be examined; endometrial specimens almost always yield positive culture results. Customize your JAMA Network experience by selecting one or more topics from the list below. (2006) 8:193–4. Stay connected to what's important in medical research and clinical practice, Subscribe to the most trusted and influential source ofmedical knowledge. Fang X, Mai R, Guo J, Lin N. A pre-term infant of 32 weeks gestation with congenital tuberculosis treated successfully with antituberculosis chemotherapy. Pediatr Pathol 1992;12:707-716, 26. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. Accurately documenting a maternal history of TB and any clinical symptoms of the disease are critical for early diagnosis. Airborne precautions are recommended for the following pediatric patients: (1) children and adolescents with adult-type cavitary disease, (2) extensive pulmonary infection, (3) those with smears positive for AFB, and (4) congenitally infected neonates undergoing endotracheal intubation (American Academy of Pediatrics, 2009). Lee JS, Lim CH, Kim E, Lim H, Lee Y, Choung JT, et al. Received: 28 January 2019; Accepted: 05 June 2019; Published: 21 June 2019. Congenital tuberculosis associated with maternal asymptomatic endometrial tuberculosis. A positive result of an acid-fast smear of gastric or tracheal aspirates in a neonate is almost diagnostic, because false-positive smear results are rare. Congenital tuberculosis is very rare, occurring when a mother with active tuberculosis transmits the infection to her child in utero or during delivery.40 Transplacental infection can occur before delivery; alternatively the baby may aspirate or swallow contaminated amniotic fluid.

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