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Lee S, Kim G, Park GM, Jeong J, Jung E, Lee BS, Jo E, Lee S, Yoon H, Jo KW, Kim SH, Lee J. Management of newborns and healthcare workers exposed to isoniazid-resistant congenital tuberculosis in the neonatal intensive care unit. J Hosp Infect 2024; 147:40-46. [PMID: 38432587 DOI: 10.1016/j.jhin.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Management of newborns and healthcare workers (HCWs) exposed to congenital tuberculosis (TB) in the neonatal intensive care unit (NICU) has been reported rarely. AIM To outline a contact investigation process for individuals exposed to congenital TB in the NICU and investigate nosocomial transmission. Additionally, to assess the efficacy and safety of window prophylaxis in exposed newborns. METHODS A baby, born at a gestational age of 28 + 1 weeks, was diagnosed with isoniazid-resistant congenital TB on the 39th day of admission to the level IV NICU. Newborns and HCWs exposed cumulatively for ≥8 h underwent contact investigation and follow-up for a year. FINDINGS Eighty-two newborns underwent contact investigation. All newborns displayed normal chest X-rays, and 42 hospitalized newborns tested negative for acid-fast bacilli stain and Xpert® MTB/RIF assay in their endotracheal sputum or gastric juices. Eighty received window prophylaxis: six of 75 on rifampin experienced mild adverse events, and none of the five on levofloxacin. After 12 weeks, five (6.1%) had a positive tuberculin skin test, all of whom had already received the Bacillus Calmette-Guérin vaccine and tested negative on TB interferon-gamma releasing assay. Of 119 exposed HCWs, three (2.5%) were diagnosed with latent TB infection and completed a four-month rifampin therapy. There was no active TB disease among exposed newborns and HCWs during a one-year follow-up. CONCLUSION Timely diagnosis of congenital TB is crucial for minimizing transmission among exposed neonates and HCWs in the NICU setting. In cases of isoniazid-resistant index patients, even premature newborns may consider the use of rifampin or levofloxacin for window prophylaxis.
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Affiliation(s)
- S Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - G Kim
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - G-M Park
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Jeong
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - E Jung
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - B S Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - E Jo
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - S Lee
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - H Yoon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - K-W Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - S-H Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea; Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Office for Infection Control, Asan Medical Center, Seoul, South Korea.
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Diel R, Nienhaus A. Risk of tuberculosis transmission by children to healthcare workers - a comprehensive review. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc13. [PMID: 37405249 PMCID: PMC10316281 DOI: 10.3205/dgkh000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Background Healthcare workers (HCWs) are at increased risk of becoming infected with M. tuberculosis complex (Mtbc). Objective To assess the magnitude of Mtbc transmission by children under the age of 15 years to HCW. Methods Medline, Google Scholar and Cochrane library were searched to select primary studies in which a child was the presumed index case and exposed HCW were screened for latent TB infection (LTBI). Results Of 4,702 abstracts, 15 original case reports covering 16 children with TB were identified. In sum, 1,395 HCW were contact persons and underwent testing. Ten of the studies reported TST conversion, amounting to 35 (2.9%) of the 1,228 HCW tested. In three of the TST-based and both of the studies that used IGRA testing, conversion was absent. 12 of the 15 studies (80%) reported exposure of HCW in neonatal intensive units (NICUs) to premature infants suffering from congenital pulmonary TB. One study including two infants addressed possible pulmonary Mtbc transmission in a general pediatric ward. Extrapulmonary transmission by aerosolized Mtbc was suggested in two patients, an infant with tuberculous peritonitis and a 12-year-old adolescent with pleurisy, and culture-confirmed only after the child had undergone video-assisted thoracoscopic surgery. Routine use of protective facemasks by HCW before exposure was not mentioned in any of the included studies. Conclusions The results suggest that the risk of Mtbc transmission from children to HCW is low. Particular attention should be paid to infection risk during respiratory manipulations in NICUs. The consistent wearing of facemasks may further reduce the risk of Mtbc transmission.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
- LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Albert Nienhaus
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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Pop R, Kaelin MB, Kuster SP, Sax H, Rampini SK, Zbinden R, Relly C, Zacek B, Bassler D, Fontijn JR, Berger C. Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit. Antimicrob Resist Infect Control 2022; 11:148. [PMID: 36471416 PMCID: PMC9720914 DOI: 10.1186/s13756-022-01179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Several neonatal intensive care units (NICU) have reported exposure to sputum smear positive tuberculosis (TB). NICE guidelines give support regarding investigation and treatment intervention, but not for contact definitions. Data regarding the reliability of any interferon gamma release assay (IGRA) in infants as a screening test for TB infection is scarce. We report an investigation and management strategy and evaluated the viability of IGRA (T-Spot) in infants and its concordance to the tuberculin skin test (TST). METHODS We performed an outbreak investigation of incident TB infection in a NICU after prolonged exposure to sputum smear positive miliary TB by an infant's mother. We defined individual contact definitions and interventions and assessed secondary attack rates. In addition, we evaluated the technical performance of T-Spot in infants and compared the results with the TST at baseline investigation. RESULTS Overall, 72 of 90 (80%) exposed infants were investigated at baseline, in 51 (56.7%) of 54 (60%) infants, follow-up TST at the age of 6 months was performed. No infant in our cohort showed a positive TST or T-Spot at baseline. All blood samples from infants except one responded to phytohemagglutinin (PHA), which was used as a positive control of the T-Spot, demonstrating that cells are viable and react upon stimulation. 149 of 160 (93.1%) exposed health care workers (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection. 5 of 92 (5.5%) exposed primary contacts were tested positive, all coming from countries with high TB incidences. In total, 1 of 342 exposed contacts was newly diagnosed with latent TB infection. The secondary attack rate in this study including pediatric and adult contacts was 0.29%. CONCLUSION This investigation highlighted the low transmission rate of sputum smear positive miliary TB in a particularly highly susceptible population as infants. Our expert definitions and interventions proved to be helpful in terms of the feasibility of a thorough outbreak investigation. Furthermore, we demonstrated concordance of T-Spot and TST. Based on our findings, we assume that T-Spot could be considered a reliable investigation tool to rule out TB infection in infants.
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Affiliation(s)
- Roxana Pop
- grid.7400.30000 0004 1937 0650Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Marisa B. Kaelin
- grid.7400.30000 0004 1937 0650Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Stefan P. Kuster
- grid.7400.30000 0004 1937 0650Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hugo Sax
- grid.7400.30000 0004 1937 0650Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Silvana K. Rampini
- grid.7400.30000 0004 1937 0650Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reinhard Zbinden
- grid.7400.30000 0004 1937 0650Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Christa Relly
- grid.7400.30000 0004 1937 0650University Children’s Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, Zurich, Switzerland
| | - Bea Zacek
- TB Centre of the Lung Association of Canton Zurich (Verein Lunge Zürich), Zurich, Switzerland
| | - Dirk Bassler
- grid.7400.30000 0004 1937 0650Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jehudith R. Fontijn
- grid.7400.30000 0004 1937 0650Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Berger
- grid.7400.30000 0004 1937 0650University Children’s Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, Zurich, Switzerland
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Matsuda A, Nishizaki N, Abe H, Mizutani A, Niizuma T, Obinata K, Oguma K, Makino S, Ishitate M, Shimizu T. An infant of 26 weeks gestation with congenital miliary tuberculosis complicated by chronic lung disease requiring CPAP was diagnosed on Day 104 of life: congenital tuberculosis was confirmed by detection of calcified ovaries in his mother. Paediatr Int Child Health 2022; 42:72-77. [PMID: 35588163 DOI: 10.1080/20469047.2022.2076030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Early diagnosis of tuberculosis (TB) in infants is important but is commonly missed because the symptoms are often non-specific. CASE PRESENTATION A Nepalese male infant born at 26 weeks gestation and weighing 1227 g (97th centile) was admitted to the neonatal intensive care unit (NICU) immediately after birth for the management of his prematurity. After extubation on Day 8, his oxygen saturation became unstable and he required nasal continuous positive airway pressure with oxygen for 3 months. On Day 104, further detailed evaluation was required because there was no improvement in his respiratory condition. A computed tomography (CT) scan demonstrated scattered miliary nodules in both lung fields. Acid-fast staining for the mycobacteria and TB polymerase chain reaction (PCR) of the sputum obtained directly by laryngeal aspiration confirmed Mycobacterium tuberculosis. On Day 105, he was therefore transferred to a tertiary care hospital for further intensive care. Pathology findings suggested placental involvement with TB owing to chronic endometrial infection. In addition, a maternal abdominal CT scan demonstrated bilateral calcified lesions in the ovaries. He completed antituberculous chemotherapy and was discharged 3 months later. At 18 months of age there are no sequelae and his development is almost normal. None of the infants or medical personnel who were exposed in the NICU developed secondary TB. CONCLUSION In neonates with persistent respiratory distress, neonatologists should consider TB infection as a differential diagnosis. ABBREVIATIONS CLD: chronic lung disease; CRP: C-reactive protein; CT: computed tomography; IGRA: interferon-γ release assay; IVF-ET: in vitro fertilisation-embryo transfer; N-CPAP: nasal continuous positive airway pressure; NICU: neonatal intensive care unit; PCR: polymerase chain reaction; PROM: premature rupture of membranes; TB: tuberculosis; WBC: white blood cells.
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Affiliation(s)
- Akina Matsuda
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naoto Nishizaki
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hanako Abe
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akira Mizutani
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takahiro Niizuma
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kaoru Obinata
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kyoko Oguma
- Department of Obstetrics and Gynaecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynaecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Makoto Ishitate
- Department of Respiratory Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Paediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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Ryu BH, Baek EH, Kim DH, Kim SE, Kim HJ, Cho OH, Hong SI, Do HJ, Park CH. 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. Jpn J Infect Dis 2020; 74:97-101. [PMID: 32741929 DOI: 10.7883/yoken.jjid.2020.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Byung-Han Ryu
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Eun-Hwa Baek
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Da-Hye Kim
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Se-Eun Kim
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Hyun-Ju Kim
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Oh-Hyun Cho
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Sun In Hong
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Hyun-Jeong Do
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Chan-Hoo Park
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Republic of Korea
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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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7
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Rinsky JL, Farmer D, Dixon J, Maillard JM, Young T, Stout J, Ahmed A, Fleischauer A, MacFarquhar J, Moore Z. Notes from the Field: Contact Investigation for an Infant with Congenital Tuberculosis Infection - North Carolina, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:670-671. [PMID: 29902167 PMCID: PMC6002032 DOI: 10.15585/mmwr.mm6723a5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
We describe a case of sputum smear-negative pulmonary tuberculosis in an adolescent boy, where a delay in diagnosis and institution of appropriate infection control measures resulted in transmission of infection to at least 3 and possibly as many as 6 healthcare workers. Lapses in the use of standard precautions for infection control were also identified.
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Ahn JG, Kim DS, Kim KH. Nosocomial exposure to active pulmonary tuberculosis in a neonatal intensive care unit. Am J Infect Control 2015; 43:1292-5. [PMID: 26307044 DOI: 10.1016/j.ajic.2015.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Nosocomial transmission of tuberculosis (TB) in a neonatal intensive care unit (NICU) is a recognized risk. We investigated TB transmission to neonates and health care workers (HCWs) exposed to a nurse with active TB in a NICU. METHODS A NICU nurse in a tertiary referral hospital in Seoul, Korea, developed pulmonary TB. The investigation included 108 infants and 75 HCWs. Tuberculin skin test (TST) and chest radiograph were performed at baseline. Isoniazid prophylaxis was started in neonates. After 3 months of prophylaxis, infants underwent repeat TST and chest radiograph. HCWs underwent a second TST after 3 months. RESULTS Baseline chest radiographs were negative in infants and HCWs. Four (3.7%) of 108 infants screened had a positive TST, including 2 conversions, and received isoniazid for 6-9 months. Among the 59 HCWs screened, 27 (45.8%) had an initial positive TST result, and 6 (10.2%) had a positive TST result at 3 months. Four of the 6 HCWs with TST conversions received isoniazid treatment for 9 months. In the 2-year period after exposure, none of the exposed infants or HCWs developed active TB. CONCLUSION In this investigation, 4 (3.7%) of 108 infants exposed to a nurse with active TB developed latent TB infection. They were given isoniazid therapy without any adverse events and did not progress to TB disease in the 2 years after exposure.
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Baquero-Artigao F, Mellado Peña M, del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez M. Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (ii): Prophylaxis and treatment. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pavlinac PB, Naulikha JM, John-Stewart GC, Onchiri FM, Okumu AO, Sitati RR, Cranmer LM, Lokken EM, Singa BO, Walson JL. Mycobacterium tuberculosis Bacteremia Among Acutely Febrile Children in Western Kenya. Am J Trop Med Hyg 2015; 93:1087-91. [PMID: 26324730 DOI: 10.4269/ajtmh.15-0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/13/2015] [Indexed: 12/28/2022] Open
Abstract
In children, Mycobacterium tuberculosis (M. tuberculosis) frequently disseminates systemically, presenting with nonspecific signs including fever. We determined prevalence of M. tuberculosis bacteremia among febrile children presenting to hospitals in Nyanza, Kenya (a region with high human immunodeficiency virus (HIV) and M. tuberculosis prevalence). Between March 2013 and February 2014, we enrolled children aged 6 months to 5 years presenting with fever (axillary temperature ≥ 37.5°C) and no recent antibiotic use. Blood samples were collected for bacterial and mycobacterial culture using standard methods. Among 148 children enrolled, median age was 3.1 years (interquartile range: 1.8-4.1 years); 10.3% of children were living with a household member diagnosed with M. tuberculosis in the last year. Seventeen percent of children were stunted (height-for-age z-score < -2), 18.6% wasted (weight-for-height z-score < -2), 2.7% were HIV-infected, and 14.2% were HIV-exposed uninfected. Seventeen children (11.5%) had one or more signs of tuberculosis (TB). All children had a Bacille Calmette-Guerin vaccination scar. Among 134 viable blood cultures, none (95% confidence interval: 0-2.7%) had Mycobacterium isolated. Despite exposure to household TB contacts, HIV exposure, and malnutrition, M. tuberculosis bacteremia was not detected in this pediatric febrile cohort, a finding consistent with other pediatric studies.
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Affiliation(s)
- Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jaqueline M Naulikha
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Grace C John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Frankline M Onchiri
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Albert O Okumu
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ruth R Sitati
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lisa M Cranmer
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Erica M Lokken
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Benson O Singa
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Kenya Medical Research Institute (KEMRI)/CGHR Centre for Global Health Research, Kisumu, Kenya; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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12
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Schechner V, Lessing JB, Grisaru-Soen G, Braun T, Abu-Hanna J, Carmeli Y, Aviram G. Preventing tuberculosis transmission at a maternity hospital by targeted screening radiography of migrants. J Hosp Infect 2015; 90:253-9. [PMID: 25986164 DOI: 10.1016/j.jhin.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 03/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Israel has been the destination of large numbers of illegal migrants from East African countries in recent years. Despite efforts to detect and treat active tuberculosis (TB) at the border, 75% of all active TB cases diagnosed in our hospital were illegal migrants. In 2012, there was a large-scale TB exposure in our maternity ward, neonatal, and paediatric intensive care units following the admission of an infectious but apparently asymptomatic migrant who was in labour. A hospital-wide screening programme was subsequently implemented to prevent exposure of patients and staff to TB. AIM To report the results of the first year of this intervention in the maternity hospital. METHODS All illegal migrants from countries where TB is highly prevalent were screened by chest radiography (CR) upon admission to the maternity hospital. The results were immediately categorized by a radiologist as either 'suggestive of active pulmonary TB' or 'non-suggestive'. Patients with CR suggestive of TB were placed in airborne isolation and underwent further evaluation. FINDINGS Four hundred and thirty-one apparently asymptomatic migrant women underwent CR screening. Most (363, 84%) presented in labour. Eleven women (2.6%) had a CR suggestive of active pulmonary TB which was confirmed in three (0.7% of screened women). No TB cases were missed by the CRs. Neither patients nor hospital staff were exposed to TB. CONCLUSION Targeted CR screening for TB among high-risk women upon their admission to a maternity hospital had a high yield and was an effective strategy to prevent in-hospital transmission of TB.
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Affiliation(s)
- V Schechner
- Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - J B Lessing
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Grisaru-Soen
- Department of Pediatrics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Braun
- Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Abu-Hanna
- Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Carmeli
- Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Aviram
- Department of Radiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Tuberculosis remains a prevalent disease worldwide, with approximately 9 million cases diagnosed annually. The emergence of multidrug-resistant tuberculosis has proven to be a challenging international public health issue. In the United States, however, the incidence of tuberculosis has been decreasing since 1992. There were just over 9,500 reported cases in 2013, and almost 500 of those were in children younger than age 15 years. Foreign-born persons are a high-risk group and account for 65% of new cases annually. Other high-risk groups include ethnic minorities, HIV-infected patients, and people living in low-socioeconomic urban areas.
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[Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (ii): Prophylaxis and treatment]. An Pediatr (Barc) 2015; 83:286.e1-7. [PMID: 25754314 DOI: 10.1016/j.anpedi.2015.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/31/2014] [Accepted: 01/19/2015] [Indexed: 11/21/2022] Open
Abstract
In pregnant women who have been exposed to tuberculosis (TB), primary isoniazid prophylaxis is only recommended in cases of immunosuppression, chronic medical conditions or obstetric risk factors, and close and sustained contact with a patient with infectious TB. Isoniazid prophylaxis for latent tuberculosis infection (LTBI) is recommended in women who have close contact with an infectious TB patient or have risk factors for progression to active disease. Otherwise, it should be delayed until at least three weeks after delivery. Treatment of TB disease during pregnancy is the same as for the general adult population. Infants born to mothers with disseminated or extrapulmonary TB in pregnancy, with active TB at delivery, or with postnatal exposure to TB, should undergo a complete diagnostic evaluation. Primary isoniazid prophylaxis for at least 12 weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Isoniazid for 9 months is recommended in LTBI. Treatment of neonatal TB disease is similar to that of older children, but should be maintained for at least 9 months. Respiratory isolation is recommended in congenital TB, and in postnatal TB with positive gastric or bronchial aspirate acid-fast smears. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. Breastfeeding is not contraindicated, and in case of mother-infant separation expressed breast milk feeding is recommended.
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Fisher KE, Guaran R, Stack J, Simpson S, Krause W, For KD, Ryan E, Conaty S, Hope K, Isaacs D, Chay P, Eastwood J, Marks GB. Nosocomial Pulmonary Tuberculosis Contact Investigation in a Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2015; 34:754-6. [DOI: 10.1086/670995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The diagnosis of smear-positive pulmonary tuberculosis in a medical officer working in a metropolitan Australian neonatal intensive care unit led to a contact investigation involving 125 neonates, 165 relatives, and 122 healthcare workers with varying degrees of exposure. There was no evidence of nosocomial tuberculosis transmission from the index case.
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16
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Mouchet F, Hansen V, Van Herreweghe I, Vandenberg O, Van Hesse R, Gérard M, Toppet M, Wanlin M, Toppet V, Casimir G, Haumont D, Levy J. Tuberculosis in Healthcare Workers Caring for a Congenitally Infected Infant. Infect Control Hosp Epidemiol 2015; 25:1062-6. [PMID: 15636293 DOI: 10.1086/502344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To assess the extent of nosocomial transmission of tuberculosis among infants, family members, and healthcare workers (HCWs) who were exposed to a 29-week-old premature infant with congenital tuberculosis, diagnosed at 102 days of age.Design:A prospective exposure investigation using tuberculin skin test (TST) conversion was conducted. Contacts underwent two skin tests 10 to 12 weeks apart. Clinical examination and chest radiographs were performed to rule out disease. Isoniazid prophylaxis was administered to exposed infants at higher risk.Setting:A neonatal intensive care unit in an urban hospital in Brussels, Belgium.Participants:Ninety-seven infants, 139 HCWs, and 180 visitors.Results:Newly positive TST results occurred in HCWs who had been in close contact with the infant. Six (19%) of 32 primary care nurses and physicians had TST conversions and received treatment. Among the 97 exposed infants, 85 were screened and 34 were identified as at higher risk of infection. Of these, 27 received preventive isoniazid. None of the infants and none of the 93 other infants' family members evaluated were infected.Conclusions:Congenital tuberculosis in an infant poses a risk for nosocomial transmission to HCWs. Delayed diagnosis of this rare disease and close proximity are the most important factors related to transmission.
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Affiliation(s)
- Francoise Mouchet
- Department of Pediatrics, St. Pierre University Hospital, Brussels, Belgium
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17
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Fisher KE, Cook NF, Marks GB. Costs of a contact screening activity in a neonatal intensive care unit. NEW SOUTH WALES PUBLIC HEALTH BULLETIN 2013; 24:29-31. [PMID: 23849026 DOI: 10.1071/nb12108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Kate E Fisher
- Department of Community Paediatrics, South Western Sydney Local Health District
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18
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Peng W, Yang J, Liu E. Analysis of 170 cases of congenital TB reported in the literature between 1946 and 2009. Pediatr Pulmonol 2011; 46:1215-24. [PMID: 21626715 DOI: 10.1002/ppul.21490] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 03/24/2011] [Accepted: 03/26/2011] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Wansheng Peng
- Department of Pediatrics, the First Affiliation Hospital of Bengbu Medical College, Bengbu, PR China
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19
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20
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Ford-Jones EL. An approach to the diagnosis of congenital infections. Paediatr Child Health 2011; 4:109-12. [PMID: 20212971 DOI: 10.1093/pch/4.2.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E L Ford-Jones
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario
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21
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Abstract
The diagnosis of congenital tuberculosis (TB) is often difficult as clinical signs are nonspecific. The maternal history of TB therefore remains an important tool in the diagnosis of congenital TB. In this case report, we present a patient with congenital TB, whose diagnosis was delayed because the mother was asymptomatic and there was a delay in eliciting a family history of TB. This highlights the importance of obtaining a detailed history on admission.
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22
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Abstract
A 73-day-old female infant presented with cough and fever. A chest roentgenogram showed a pneumonic patch, but empirical antibiotic treatment failed. The pathology of an excisional biopsy specimen confirmed pulmonary tuberculosis. We emphasize that tuberculosis should be considered for neonates or infants with unresponsive pneumonia because delayed diagnosis is associated with a fatal outcome.
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23
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Stuart RL, Lewis A, Ramsden CA, Doherty RR. Congenital tuberculosis after in-vitro fertilisation. Med J Aust 2009; 191:41-2. [PMID: 19580539 DOI: 10.5694/j.1326-5377.2009.tb02676.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 03/16/2009] [Indexed: 11/17/2022]
Abstract
A 6-week old infant who had been conceived through in-vitro fertilisation (IVF) presented with a skin lesion and enlarged lymph nodes, and developed severe respiratory distress. Mycobacterium tuberculosis was identified; his mother was the only potential source identified. To our knowledge, this is the first case of congenital tuberculosis after IVF reported in Australia and the second worldwide. It highlights the importance of adequate screening during investigation of infertility and the difficulties in diagnosing congenital tuberculosis.
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Affiliation(s)
- Rhonda L Stuart
- Monash Medical Centre, Southern Health, Melbourne, VIC, Australia.
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24
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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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25
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[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008. [PMID: 18041117 PMCID: PMC7080031 DOI: 10.1007/s00103-007-0337-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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26
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Nicolaidou P, Psychou F, Stefanaki K, Tsitsika A, Syriopoulou V. Congenital tuberculosis: a case report. Clin Pediatr (Phila) 2005; 44:451-3. [PMID: 15965553 DOI: 10.1177/000992280504400511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Sen M, Gregson D, Lewis J. Neonatal exposure to active pulmonary tuberculosis in a health care professional. CMAJ 2005; 172:1453-6. [PMID: 15911860 PMCID: PMC557981 DOI: 10.1503/cmaj.1031052] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Nosocomial transmission of tuberculosis (TB) is a recognized risk. Although many outbreaks of TB in health care settings have been reported, there are few cases of nosocomial transmission to neonates. We report our experience in investigating and managing the exposure over 16 days of 124 neonates, 301 visitors and 219 health care workers to a health care worker with active TB in a neonatal intensive care unit.
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Affiliation(s)
- Mithu Sen
- Division of Respirology, University of Western Ontario, London Health Sciences Centre and St. Joseph's Health Centre, London, Ont.
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28
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Chang ML, Jou ST, Wang CR, Chung MT, Lai SH, Wong KS, Huang YC, Chou YH. Connatal tuberculosis in a very premature infant. Eur J Pediatr 2005; 164:244-7. [PMID: 15616826 DOI: 10.1007/s00431-004-1600-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2004] [Accepted: 10/27/2004] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Mei-Ling Chang
- Division of Neonatology, Department of Paediatrics, Chang Gung Children's Hospital, 5 Fu Hsing Street, Kweishan 333 Taoyuan, Taiwan
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29
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Crockett M, King SM, Kitai I, Jamieson F, Richardson S, Malloy P, Yaffe B, Reynolds D, Hellmann J, Cutz E, Matlow A. Nosocomial Transmission of Congenital Tuberculosis in a Neonatal Intensive Care Unit. Clin Infect Dis 2004; 39:1719-23. [PMID: 15578377 DOI: 10.1086/425740] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 07/23/2004] [Indexed: 11/03/2022] Open
Abstract
Congenital tuberculosis is uncommon, and nosocomial transmission from a congenitally infected infant to another infant has not been reported in the English literature. We report an investigation of 2 infants with tuberculosis who were cared for in the same neonatal intensive care unit. Isolates from both infants were genetically indistinguishable. Transmission between the 2 infants was likely due to contaminated respiratory equipment.
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Affiliation(s)
- Maryanne Crockett
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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30
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Richeldi L, Ewer K, Losi M, Bergamini BM, Roversi P, Deeks J, Fabbri LM, Lalvani A. T Cell–Based Tracking of Multidrug Resistant Tuberculosis Infection after Brief Exposure. Am J Respir Crit Care Med 2004; 170:288-95. [PMID: 15130907 DOI: 10.1164/rccm.200403-307oc] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Molecular epidemiology indicates significant transmission of Mycobacterium tuberculosis after casual contact with infectious tuberculosis cases. We investigated M. tuberculosis transmission after brief exposure using a T cell-based assay, the enzyme-linked-immunospot (ELISPOT) for IFN-gamma. After childbirth, a mother was diagnosed with sputum smear-positive multidrug-resistant tuberculosis. Forty-one neonates and 47 adults were present during her admission on the maternity unit; 11 weeks later, all underwent tuberculin skin testing (TST) and ELISPOT. We correlated test results with markers of exposure to the index case. The participants, who were asymptomatic and predominantly had no prior tuberculosis exposure, had 6.05 hours mean exposure (range: 0-65 hours) to the index case. Seventeen individuals, including two newborns, were ELISPOT-positive, and ELISPOT results correlated significantly with three of four predefined measures of tuberculosis exposure. For each hour sharing room air with the index case, the odds of a positive ELISPOT result increased by 1.05 (95% CI: 1.02-1.09, p = 0.003). Only four adults were TST-positive and TST results did not correlate with exposure. Thus, ELISPOT, but not TST, suggested quite extensive nosocomial transmission of multidrug-resistant M. tuberculosis after brief exposure. These results help to explain the apparent importance of casual contact for tuberculosis transmission, and may have implications for prevention.
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MESH Headings
- Adult
- BCG Vaccine/therapeutic use
- Cross Infection/diagnosis
- Cross Infection/drug therapy
- Cross Infection/immunology
- Cross Infection/microbiology
- Cross Infection/transmission
- Disease Transmission, Infectious/classification
- Drug Resistance, Multiple/immunology
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Hypersensitivity, Delayed/complications
- Hypersensitivity, Delayed/immunology
- Infant, Newborn
- Interferon-gamma
- Male
- Mycobacterium tuberculosis
- Odds Ratio
- Sensitivity and Specificity
- T-Lymphocytes/immunology
- Time Factors
- Tuberculin Test
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/immunology
- Tuberculosis, Multidrug-Resistant/microbiology
- Tuberculosis, Multidrug-Resistant/transmission
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Affiliation(s)
- Luca Richeldi
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom
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31
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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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32
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Abstract
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.
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Affiliation(s)
- Yi-Hung Chou
- Division of Neonatology, Chang Gung Children's Hospital, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
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33
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Muñoz FM, Ong LT, Seavy D, Medina D, Correa A, Starke JR. Tuberculosis among adult visitors of children with suspected tuberculosis and employees at a children's hospital. Infect Control Hosp Epidemiol 2002; 23:568-72. [PMID: 12400884 DOI: 10.1086/501972] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Few children with tuberculosis (TB) have communicable disease, and most do not require isolation within the hospital. However, parents or adult visitors with unrecognized pulmonary TB may be a threat to hospital staff and other patients. We prospectively evaluated adults accompanying children hospitalized for suspected TB at a children's hospital to determine the frequency of undiagnosed, potentially contagious disease. METHODS From 1992 to 1998, chest radiographs were obtained from adult caretakers accompanying 59 consecutive children admitted to Texas Children's Hospital with suspected TB. A child and his or her family were placed under Airborne Precautions only if the child or the accompanying adult exhibited characteristics of potentially contagious disease. Annual rates of tuberculin skin test conversion in hospital employees were obtained for the same period. RESULTS Of the 105 screened adults, 16 (15%) had previously undetected pulmonary TB. These adults were associated with 14 (24%) of the 59 children. In all instances in which the adult was the patient's parent, he or she was the source of infection to the child. Only 8 (13.5%) of the 59 children required isolation. Tuberculin skin test conversion from a negative to a positive reaction occurred in 127 employees (8 per 1,000 employee-years at risk). Only 4 of these 127 employees performed activities involving direct patient contact. None was in contact with families with a known potentially contagious adult or pediatric patient. CONCLUSIONS The risk of infection of healthcare workers from pediatric patients with primary TB appeared to be minimal, and most children with TB did not need isolation. Infection control efforts should be focused on accompanying adults and adult visitors.
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Affiliation(s)
- Flor M Muñoz
- Department of Molecular Virology, Baylor College of Medicine, Houston, Texas 77030, USA
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34
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Laartz BW, Narvarte HJ, Holt D, Larkin JA, Pomputius WF. Congenital tuberculosis and management of exposures in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2002; 23:573-9. [PMID: 12400885 DOI: 10.1086/501973] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Brent W Laartz
- Division of Infectious Diseases, University of South Florida, Tampa General Healthcare, 33601-1289, USA
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35
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Affiliation(s)
- L J Akinbami
- Children's National Medical Center, Washington, DC, USA
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36
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Starke JR. Transmission of mycobacterium tuberculosis to and from children and adolescents. ACTA ACUST UNITED AC 2001. [DOI: 10.1053/spid.2001.22785] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Mazade MA, Evans EM, Starke JR, Correa AG. Congenital tuberculosis presenting as sepsis syndrome: case report and review of the literature. Pediatr Infect Dis J 2001; 20:439-42. [PMID: 11332672 DOI: 10.1097/00006454-200104000-00014] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- M A Mazade
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
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38
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Curtis AB, Ridzon R, Vogel R, McDonough S, Hargreaves J, Ferry J, Valway S, Onorato IM. Extensive transmission of Mycobacterium tuberculosis from a child. N Engl J Med 1999; 341:1491-5. [PMID: 10559449 DOI: 10.1056/nejm199911113412002] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND METHODS Young children rarely transmit tuberculosis. In July 1998, infectious tuberculosis was identified in a nine-year-old boy in North Dakota who was screened because extrapulmonary tuberculosis had been diagnosed in his female guardian. The child, who had come from the Republic of the Marshall Islands in 1996, had bilateral cavitary tuberculosis. Because he was the only known possible source for his female guardian's tuberculosis, an investigation of the child's contacts was undertaken. We identified family, school, day-care, and other social contacts and notified these people of their exposure. We asked the contacts to complete a questionnaire and performed tuberculin skin tests. RESULTS Of the 276 contacts of the child whom we tested, 56 (20 percent) had a positive tuberculin skin test (induration of at least 10 mm), including 3 of the child's 4 household members, 16 of his 24 classroom contacts, 10 of 32 school-bus riders, and 9 of 61 day-care contacts. A total of 118 persons received preventive therapy, including 56 young children who were prescribed preventive therapy until skin tests performed at least 12 weeks after exposure were negative. The one additional case identified was in the twin brother of the nine-year-old patient. The twin was not considered infectious on the basis of a sputum smear that was negative on microscopical examination. CONCLUSIONS This investigation showed that a young child can transmit Mycobacterium tuberculosis to a large number of contacts. Children with tuberculosis, especially cavitary or laryngeal tuberculosis, should be considered potentially infectious, and screening of their contacts for infection with M. tuberculosis or active tuberculosis may be required.
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Affiliation(s)
- A B Curtis
- Epidemic Intelligence Service, Epidemiology Program Office, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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