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Published on: September 5, 2017
Congenital tuberculosis
Tawee Chotpitayasunondh1, Varaporn Sangtawesin
1Infectious Diseases Division, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
Insights
Congenital tuberculosis is rare and challenging to diagnose early. High suspicion is crucial for infants with unexplained pneumonia unresponsive to antibiotics.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Congenital tuberculosis is a rare but severe condition in newborns.
- Early diagnosis is often difficult due to non-specific symptoms.
Purpose of the Study:
- To review cases of congenital tuberculosis.
- To describe clinical presentation, diagnosis, and outcomes.
Main Methods:
- Retrospective study of 9 congenital tuberculosis patients (1979-1998).
- Analysis of clinical data, diagnostic tests, and outcomes.
Main Results:
- Common symptoms included fever, poor feeding, irritability, and failure to gain weight.
- Chest X-rays showed bronchopneumonia or miliary patterns.
- Bacteriological studies were positive in over 60% of cases.
- Fatality rate was 33.3%.
Conclusions:
- Congenital tuberculosis requires a high index of suspicion in neonates with pneumonia.
- Prompt diagnosis and treatment are vital for improving outcomes.
Abstract:
This is a retrospective study of congenital tuberculosis in Queen Sirikit National Institute of Child Health from 1979 to 1998. There were 9 patients with a mean birth weight of 2,500 grams (range 1,800-3,300). The onset of symptoms and age of diagnosis ranged from 7 to 42 (mean, 21) days and 14 to 75 (mean, 54) days after birth, respectively. The presenting signs and symptoms were fever (100%), poor feeding (100%), irritability (100%), failure to gain weight (100%), hepatomegaly (100%), splenomegaly (77.8%), cough (88.9%), respiratory distress (66.7%) and abdominal distension (77.8%). The tuberculin skin test reaction with > or = 10 mm induration was found in 2 of 8 patients. Their abnormal chest radiographs revealed bronchopneumonia 66.7 per cent, miliary pattern 33.3 per cent and multiple cystic lesion 11.1 per cent. The bacteriological study from gastric aspirate content for acid-fast bacilli (AFB) staining and culture were positive in 62.5 and 71.4 per cent respectively. Fatality rate was 33.3 per cent with no sequele found in the survivors. Congenital tuberculosis is a rare entity and difficult to give an early diagnosis. There should be a high index of suspicion for tuberculosis in those who had pneumonia and were unresponsive to aggressive antibiotics or had unexplained etiology.
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