Preterm Twins Born to a Mother with Miliary Tuberculosis: Importance of Early Recognition and Prompt Response in Infection Control to Manage Congenital Tuberculosis Exposure in a Neonatal Intensive Care Unit.

Delayed diagnosis of congenital tuberculosis (TB) in the neonatal intensive care unit (NICU) is a serious problem in terms of infection control. Here, we report our preemptive infection control activities implemented after the diagnosis of miliary TB in a mother of preterm twins (index twins, NB1 and NB2) in the NICU. In addition, we reviewed previous case reports of congenital TB exposure in the NICU setting. Immediately after diagnosing miliary TB in the mother, the index twins were isolated before their TB diagnosis and received preemptive anti-TB medication; contact investigations were also conducted. Eventually, NB1 was diagnosed with congenital TB at 29 days of age, and NB2 showed no definite evidence of TB. Through contact investigation, 11 of the 16 exposed infants received isoniazid prophylaxis and no positive tuberculin skin test results were obtained after 3 months. One of the 31 exposed healthcare workers showed new interferon-gamma release assay conversion. Moreover, our case showed a much shorter contagious period compared to that in previous reports (8 versus 17-102 days). This suggests that a high index of suspicion and prompt measures can help prevent congenital TB outbreaks and reduce the burden of infection control activities in the NICU.

Congenital tuberculosis in an extremely preterm infant conceived after in vitro fertilization: case report.

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.

Rifampicin pharmacokinetics in extreme prematurity to treat congenital tuberculosis.

Little evidence is available on the pharmacokinetics of antituberculous medication in premature infants. We report rifampicin (RMP) pharmacokinetics in an extremely premature, low-birthweight female infant born to a mother with known miliary tuberculosis. Intravenous RMP, isoniazid (INH), ciprofloxacin and amikacin were used, as the enteral route was not possible. Area under the curve calculations revealed low average RMP concentrations at doses of 5-10 mg/kg. We review the literature with regard to the dosing regimen and therapeutic drug levels of RMP and INH in premature infants and discuss issues of management. Evidence from this case suggests 10 mg/kg/day is the minimum dose required.

Analysis of 170 cases of congenital TB reported in the literature between 1946 and 2009.

INTRODUCTION: Congenital tuberculosis is a rare disease. The mortality is very high. Through a review of our own cases and the world literature, we describe clinical manifestations, treatment, and prognosis of this disease. METHODS: A total of 170 subjects with congenital tuberculosis that 6 cases identified by the authors and 164 cases identified in other case series were included in this study. All patients were diagnosed according to Cantwell's criteria. The data were analyzed using SPSS, version 17.0 spss. RESULTS: There were 70 premature babies among the 170 infants with congenital tuberculosis. The average onset age was 20 days. The mothers of 162 patients were diagnosed as having active tuberculosis during pregnancy or after parturition. Nonspecific signs and symptoms were found in these 170 cases, such as fever, respiratory distress, and hepatosplenomegaly, etc. Abnormal chest radiographs were found in 133 infants, of whom 83 cases showed miliary tuberculosis and multiple pulmonary nodules. Sixty-eight infants died from among the 169 cases. The mortality dropped to 21.7% after treatment with anti-tuberculosis medication. The blood leukocyte count (P < 0.001), anti-tuberculosis treatment (P < 0.001), age of onset (P = 0.004), and presence of intracranial lesions (P < 0.001) affected the prognosis of congenital tuberculosis. CONCLUSIONS: The majority of infants with congenital tuberculosis onset within 2-3 weeks after delivery had no specific manifestations. Anti-tuberculosis medication could reduce the mortality. The age of onset, presence of intracranial lesions, anti-tuberculosis treatment, specific image performances and leukocyte count were related to the prognosis of congenital tuberculosis.

Feeding intolerance due to connatal tuberculosis in a prematurely born infant.

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.

Tuberculosis congénita asociada con tuberculosis materna miliar diseminada / Congenital tuberculosis associated with maternal disseminated miliary tuberculosis

La tuberculosis sin tratamiento en mujeres gestantes es un riesgo definido para la transmisión de la enfermedad al recién nacido y para resultados adversos, obstétricos y perinatales. La tuberculosis en mujeres gestantes y la tuberculosis congénita son afecciones infrecuentes y de difícil diagnóstico por la falta de especificidad de las manifestaciones clínicas. Se presenta el caso de una mujer primigestante con tuberculosis miliar diseminada, con inicio de las manifestaciones en el puerperio inmediato, diagnóstico en el segundo mes del puerperio y desenlace fatal. Además, se presenta el caso de su hijo prematuro con manifestaciones desde el nacimiento, evidencia de complejo pulmonar primario, atelectasia persistente por obstrucción bronquial por las adenopatías e infección por citomegalovirus; recibió tratamiento estándar con mejoría.

Untreated tuberculosis during pregnancy presents a serious risk for transmission of disease to the newborn and can result in adverse perinatal and obstetrical outcomes. Tuberculosis during pregnancy and congenital tuberculosis are infrequent conditions and are difficult to diagnose due the non-specificity of the symptoms. A case report is presented of a woman who had no children previously with disseminated miliary tuberculosis. Tuberculosis symptoms appeared immediately after birth of the first child, with a clinical diagnosis on the second month after childbirth, whereupon the patient died. The son, a premature infant, showed disease symptoms from the first day, with primary pulmonary complex and persistent atelectasis due to bronchial obstruction. The obstruction was due to thoracic lymphadenitis and coinfection with cytomegalovirus. The infant received standard treatment and his condition improved.

Connatal tuberculosis in a very premature infant.

UNLABELLED: Connatal tuberculosis is increasing in incidence and the mortality and morbidity of this disease remains high. We report a 27-week-old, 896 g female premature infant who had mild respiratory distress syndrome after birth. She developed signs of infection, progressive pneumonia and atelectasis which did not respond to mechanical ventilation and antibiotics. At 41 days of age, Mycobacterium tuberculosis was isolated from the non-bronchoscopic bronchoalveolar lavage. The isolate was sensitive to isoniazid, rifampin, streptomycin, and pyrazinamide. Miliary tuberculosis was subsequently diagnosed in her mother on a chest X-ray film and sputum cultures. The infant was treated successfully with anti-tuberculosis drugs. She had normal growth and development at the chronological age of 20 months old. CONCLUSION: Connatal tuberculosis should be considered in premature infants with symptoms of sepsis refractory to antibiotics. Most premature infants with connatal tuberculosis have lung involvement, and non-bronchoscopic bronchoalveolar lavage can be a useful procedure to establish the diagnosis.

[Congenital miliary tuberculosis. Apropos of a case]. / Miliaire tuberculeuse congénitale. A propos d'un cas.

Congenital tuberculosis is an uncommon but probably underestimated disease. All cases occurring in developing countries are not published. Twenty-nine cases have been published in the English literature since 1980. The diagnosis of congenital tuberculosis is different from post-natal tuberculosis and is based on recently defined criteria: bacteriologically proven tuberculosis in a new-born associated with at least one of the following: specific hepatic granulomatosis, tuberculosis infection of the placenta or maternal genital tract, exclusion of possible post-natal transmission. We report a case of congenital tuberculosis to be added to the 29 preceding cases meeting current diagnostic criteria.

Congenital miliary tuberculosis with intestinal perforations.

The case of a male preterm baby who had congenital miliary tuberculosis with multiple intestinal perforations is reported. The patient was successfully treated with antituberculosis chemotherapy and surgical repair along with other supportive therapy. This is one of the rarest cases of the type described here.

Tuberculosis miliar congénita en un recién nacido de pre-término: tratamiento exitoso / Congenital miliary tuberculosis in a preterm newborn: successful treatment

Se presenta el caso de un recién nacido de 33 semanas de gestación de sexo femenino que presenta una TBC miliar diagnosticada a los 16 días de vida. Se trataría de una tuberculosis congénita con marcadísimos antecedentes familiares de tuberculosis, la madre desarrolló una TBC miliar durante el período de parto. El neonato recibió ventilación mecánica durante 34 días. Las baciloscopías de secreción traqueal fueron positivas hasta los 20 días de tratamiento; el ventilador mecánico dió salida a bacilos por la válvula espiratoria hasta el día 13 de uso; fue tratada con Isoniacida y Rifampicina y Pirazinamida por 60 dosis diarias y luego Isoniacida y Rifampicina dos veces por semana con 42 dosis con muy buena respuesta terapéutica, regresión de imágenes radiológicas miliares, buena curva de crecimiento pondo-estatural y adecuado desarrollo psicomotor. La tuberculina con 2U de PPD fue de 0 mm al momento de su alta en el 7§ mes de vida. Actualmente la madre está sana

Perinatally acquired neonatal tuberculosis: report of two cases.

Perinatally acquired neonatal tuberculosis occurs rarely, is difficult to diagnose, may be the indicator of untreated tuberculosis in the mother, and could result in nosocomial transmission to neonatal patients, visitors to neonatal intensive care units, and health care workers. The disease may be more common in certain ethnic and social groups. Neonatal mortality approaches 30%. We report two cases with different outcomes. A neonate was treated for clinical miliary tuberculosis and survived; Mycobacterium tuberculosis was cultured from bronchoscopic washings, maternal genital fluids, and tissues. A second infant died at age 46 days, and autopsy disclosed miliary tuberculosis of lungs, mediastinal and mesenteric nodes, liver, spleen, and bone marrow. The lungs were most severely affected, but the placenta and central nervous system were not involved. The histopathology was not granulomatous. After the diagnosis in the infant, the mother was ascertained to have pulmonary and genital tuberculosis. Fetal and neonatal tuberculosis could be acquired transplacentally as prenatal tuberculous chorioamnionitis, perinatally through aspiration and ingestion of infected maternal genital tissues and fluid, or postnatally through droplet spread from cases of active tuberculosis. These two neonates probably acquired the disease perinatally from maternal genital tuberculosis.

Congenital tuberculosis: a case report.

Congenital tuberculosis is a rare disease, difficult to be correctly diagnosed from clinical manifestations alone without maternal tuberculous history. In this article we report a neonate who exhibited abdominal distension and bloody diarrhea simulating neonatal sepsis and necrotizing enterocolitis. Exploratory laparatomy was performed for the markedly distended abdomen and deteriorated condition. Calcified lymph nodes over mesentery and spleen were found, and biopsy was done to show caseous tubercles. However, this neonate deteriorated rapidly and died one day after operation. Autopsy revealed generalized discrete miliary tubercles over the lungs, liver, spleen, pancreas, adrenal glands, thyroid and lymph nodes.

Congenital miliary tuberculosis.

A case of a premature baby who had the classical problems associated with congenital tuberculosis and presented a difficult diagnostic problem is described. Diagnosis was ultimately confirmed by liver biopsy. Treatment was initially with isoniazid alone, followed 2 weeks later by isoniazid and rifampicin. Isoniazid was replaced by ethambutol when an isoniazid-resistant culture was obtained. The baby responded extremely well to therapy and, at 2-year follow-up, was growing satisfactorily without any sequelae. To my knowledge, this is the first case of congenital tuberculosis with a miliary spread to be seen, treated and followed up in the developing world, where tuberculosis is prevalent.

Tuberculosis congénita / Congenital tuberculosis

La tuberculosis congénita es una entidad patológica rara, cuya incidencia es variable según la prevalencia de la enfermedad de la población. Se presenta un caso clínico correspondiente a un recién nacido prematuro, hijo de madre portadora de tuberculosis miliar, que en el período neonatal mostró signos clínicos sugerentes de sepsis y en cuyo contenido gástrico se aisló Mycobacterium tuberculosis, habiéndose descartado la exposición materna extrauterina o con personal infectado. La forma de infección materno-fetal, en este caso, probablemente fue hematógena (vía vena umbilical). La respuesta clínica del paciente al tratamiento antituberculoso fue satisfactoria. Este caso es un ejemplo de una enfermedad que, aunque poco frecuente, debe ser sospechada en toda infección neonatal de etiología no precisada, debido a la importancia de instalar el tratamiento específico precozmente para mejorar el pronóstico vital del neonato

[Congenital tuberculosis]. / Tuberculosis congénita.

Congenital tuberculosis is a rare disease of variable incidence in accordance with prevalence of the disease in the general population. We report a case in a neonate born prematurely, whose mother presented with miliary tuberculosis diagnosed in the puerperal period. The newborn had no contact with his mother after delivery, neither with other infected people. The clinical picture consisted mainly in signs and symptoms of septicaemia of gradual onset. Mycobacterium tuberculosis was isolated from gastric fluids and the response to specific treatment, was excellent. Although congenital tuberculosis is a rare disease, is should be suspected in any neonate developing signs and symptoms of sepsis of unknown etiology. The importance of an early diagnosis and treatment is stressed in order to improve neonatal survival.