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Mane S, Chopade R, Patil A, Charania K, Ganapathi D, Pustake M. Disseminated Congenital Tuberculosis in Neonates: A Case Series. J Trop Pediatr 2022; 68:6574973. [PMID: 35478048 DOI: 10.1093/tropej/fmac031] [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: 11/14/2022]
Abstract
Congenital tuberculosis (CTB) is an uncommon yet, well-defined condition. CTB has a non-specific clinical presentation, making the diagnosis difficult. The rarity of CTB in neonates is due to the difficulty in distinguishing between congenital and postnatally acquired infection, and non-specific symptoms in the newborn, which are often misdiagnosed. Though it has a low incidence, it has significant mortality if the diagnosis is delayed. We are presenting two cases of CTB in newborns who showed signs of disease in the first few days of life. The diagnosis was suspected based on chest computed tomography, magnetic resonance imaging brain, cerebrospinal fluid studies, intrauterine growth restriction, non-response to standard treatment and a maternal history of active tuberculosis. These cases highlight the significance of having a high suspicion of CTB and timely treatment for better outcomes.
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Affiliation(s)
- Sushant Mane
- Department of Pediatrics, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India
| | - Rajratna Chopade
- Department of Pediatrics, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India
| | - Aishwarya Patil
- Department of Pediatrics, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India
| | - Kaif Charania
- Department of Pediatrics, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India
| | - Deepa Ganapathi
- Department of Pediatrics, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India
| | - Manas Pustake
- Department of Pediatrics, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India
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Abstract
This review discusses the recent literature (2006-2020) about the epidemiology, clinical presentation, diagnosis, and management of infants with congenital or perinatal tuberculosis (TB). While the incidence of childhood TB is declining in the United States and worldwide, many case reports describe how clinical suspicion for neonatal TB is raised only if an ill-appearing neonate does not improve with broad-spectrum antibiotics. Furthermore, the delay in initiating appropriate anti-TB therapy often results in the need for significant cardiopulmonary support and/or an increase in mortality. This review summarizes important clinical indications in the maternal and newborn history, the evaluation of an infant with possible TB exposure, and step-by-step recommendations for the treatment and follow-up of infants with TB.
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Affiliation(s)
- Yi Shao
- Department of Pediatrics and
| | - Joseph R Hageman
- Section of Neonatology, Comer Children's Hospital, University of Chicago Medical Center, Chicago, IL
| | - Stanford T Shulman
- Division of Pediatric Infectious Disease, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Medical Center, Chicago, IL
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Bhat YR, Kini S, Halegubbi Karegowda L. Tuberculosis in a 2.5-month-old infant: congenital or acquired dilemma? Paediatr Int Child Health 2021; 41:217-220. [PMID: 33211626 DOI: 10.1080/20469047.2020.1848270] [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: 10/23/2022]
Abstract
Infants may develop congenital tuberculosis from an infectious mother or acquire the disease postnatally by contact with an infectious adult. Delayed diagnosis is common, especially in infants under 1 year of age, and, if unrecognised, there is an increased risk of death. A 2.5-month-old boy presented with respiratory distress, small inhomogeneous opacities in both lungs and hepatosplenomegaly mimicking sepsis. He had received BCG vaccination and there was no history of contact with tuberculosis (TB). He had had fever since 1 month of age for which there had been several outpatient visits. Gastric aspirate cartridge-based nucleic acid amplification test (CBNAAT) confirmed TB and sonological evaluation demonstrated multiple granulomata in the liver and spleen, and a liver biopsy supported TB. He responded well to 12 months of anti-tuberculous treatment. The mother's tuberculin test, chest radiograph and endometrial biopsy showed no evidence of TB. There was no history of tuberculous contact with close family members. Despite the lack of proof of current tuberculous TB infection in the mother, it is likely that the infant had congenital TB.
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Affiliation(s)
| | - Sandesh Kini
- Departments of PaediatricsKasturba Medical College, MAHE University, Manipal, India
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Orazulike N, Sharma JB, Sharma S, Umeora OUJ. Tuberculosis (TB) in pregnancy - A review. Eur J Obstet Gynecol Reprod Biol 2021; 259:167-177. [PMID: 33684671 DOI: 10.1016/j.ejogrb.2021.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
Tuberculosis (TB) is a common infectious pathology especially in low-income countries, which may complicate pregnancy. Although pulmonary TB is more common in pregnancy than extra pulmonary TB (EPTB), EPTB is becoming more common especially in those living with human deficiency virus (HIV) co infection or have other comorbidities. The diagnosis of TB may be delayed in pregnancy due to the masking of its symptoms by those of pregnancy. If diagnosed and treated on time both pulmonary TB and EPTB are associated with excellent maternal and perinatal outcome. If, however, there is delay in diagnosis and treatment then there could be adverse maternal and fetal consequences like preterm labour, fetal growth restriction and even stillbirths. Similarly severe forms of TB like disseminated disease (miliary TB) or multi drug resistant TB (MDR TB) are associated with poor outcome. Diagnosis and management is same as in non-pregnant patients. Both drug sensitive pulmonary TB and EPTB are treated with four drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) orally daily for 2 months followed by three drugs (isoniazid, rifampicin and ethambutol) orally daily for 4 months. Drug resistant TB is treated with second line drugs with caution, as some of these drugs are teratogenic. Optimum antenatal care and nutrition therapy along with anti-tuberculosis drugs provide for optimum maternal and perinatal outcome. This review discusses maternal and perinatal outcomes, diagnosis and management of pulmonary TB and extrapulmonary TB as well as perinatal tuberculosis.
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Affiliation(s)
- Ngozi Orazulike
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
| | - J B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Odidika U J Umeora
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
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Mekonnen GA, Gumi B, Berg S, Conlan AJK, Ameni G, Wood JLN. A case of early neonate bovine tuberculosis in Ethiopia. Clin Case Rep 2021; 9:487-490. [PMID: 33489201 PMCID: PMC7812992 DOI: 10.1002/ccr3.3563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/05/2020] [Accepted: 09/07/2020] [Indexed: 01/22/2023] Open
Abstract
This report illustrates that calves may be infected with bovine tuberculosis at early age under natural conditions and progression can be rapid. Thus, testing of calves needs to be considered in any control program to reduce the risk of transmission.
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Affiliation(s)
- Getnet Abie Mekonnen
- National Animal Health Diagnostic and Investigation CenterSebetaEthiopia
- Aklilu Lemma Institute of PathobiologyAddis Ababa UniversityAddis AbabaEthiopia
| | - Balako Gumi
- Aklilu Lemma Institute of PathobiologyAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Andrew J. K. Conlan
- Disease Dynamics UnitDepartment of Veterinary MedicineUniversity of CambridgeCambridgeUK
| | - Gobena Ameni
- Aklilu Lemma Institute of PathobiologyAddis Ababa UniversityAddis AbabaEthiopia
- Department of Veterinary MedicineCollege of Food and AgricultureUnited Arab Emirates UniversityAl AinUnited Arab Emirates
| | - James L. N. Wood
- Disease Dynamics UnitDepartment of Veterinary MedicineUniversity of CambridgeCambridgeUK
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Yeh JJ, Lin SC, Lin WC. Congenital Tuberculosis in a Neonate: A Case Report and Literature Review. Front Pediatr 2019; 7:255. [PMID: 31294005 PMCID: PMC6598396 DOI: 10.3389/fped.2019.00255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
Congenital tuberculosis (TB) is difficult to detect because the disease presents few or no symptoms in the fetus during pregnancy and nonspecific symptoms in neonates. We reviewed 20 cases of congenital TB reported between 2011 and 2017 and report a case of a mother and her 8 days old neonate with congenital TB. In these 21 cases (including our case), the most common clinical presentations were respiratory distress, fever, and hepatosplenomegaly. The most common chest imaging findings were pneumonia, multiple pulmonary nodules, and miliary pattern. The mortality rate of infants with TB was increased ~2.2-fold if their mothers had no symptoms. The case reported herein concerns an 8 days old neonate with the rare presentation of a 2 days history of fever, followed by abdominal distension without respiratory symptoms. Computed tomography (CT) imaging exhibited a large amount of right pleural effusion. Multiple antimicrobial therapies were administered to the neonate; however, his symptoms persisted. Repeat CT was used to identify a progressed disease with multiple nodules over the lung, spleen, and hepatic hilar region. Standard anti-TB medications were prescribed, and the patient recovered gradually. Both gastric lavage and pleural effusion cultures confirmed the diagnosis of TB. The neonate's mother denied any TB contact history and the diagnosis of any medical disease during pregnancy, but she experienced a fulminant course of miliary TB and was admitted to the intensive care unit 24 days postpartum. She died despite receiving anti-TB treatment. In TB-endemic areas, congenital TB should be taken into consideration when neonates develop fever, respond poorly to antimicrobial treatment, and when their mothers deny any TB contact history.
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Affiliation(s)
- Jui-Ju Yeh
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Chieh Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chuan Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Infection Control Office, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Locham J, Chandra Shaw S, Dalal S, Gupta R. Congenital tuberculosis in a neonate. Med J Armed Forces India 2019; 75:96-98. [DOI: 10.1016/j.mjafi.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022] Open
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