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Tuberculosis in a 2.5-month-old infant: congenital or acquired dilemma?
Yellanthoor Ramesh Bhat1, Sandesh Kini1, Lakshmikanth Halegubbi Karegowda2
1Departments of PaediatricsKasturba Medical College, MAHE University, Manipal, India.
Insights
Congenital tuberculosis in infants can be challenging to diagnose, often mimicking sepsis. Early detection and treatment are crucial for preventing fatal outcomes in young children with this serious infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Congenital tuberculosis (TB) is transmitted from an infected mother to her infant, either in utero or during birth.
- Postnatal TB acquisition in infants occurs through contact with infectious adults.
- Delayed diagnosis of TB in infants, particularly those under one year, increases mortality risk.
Purpose of the Study:
- To highlight the diagnostic challenges of congenital tuberculosis in infants.
- To present a case of congenital TB mimicking sepsis in a young infant.
- To emphasize the importance of considering congenital TB in infants with non-specific symptoms.
Main Methods:
- Case report of a 2.5-month-old infant presenting with respiratory distress and hepatosplenomegaly.
- Diagnostic workup included chest imaging, gastric aspirate for cartridge-based nucleic acid amplification test (CBNAAT), ultrasonography, and liver biopsy.
- Evaluation of the infant's mother for TB infection.
Main Results:
- The infant presented with symptoms mimicking sepsis, including respiratory distress and hepatosplenomegaly.
- Gastric aspirate CBNAAT confirmed tuberculosis.
- Liver and spleen showed granulomata on sonological evaluation, with biopsy supporting TB.
- The infant responded well to 12 months of anti-tuberculous therapy.
- No definitive evidence of active TB was found in the mother, despite the high likelihood of congenital transmission.
Conclusions:
- Congenital tuberculosis can present insidiously in infants, often mimicking other serious conditions like sepsis.
- Advanced diagnostic tools like CBNAAT and imaging are vital for early and accurate diagnosis.
- Even without definitive maternal TB evidence, congenital TB should be strongly suspected in infants with compatible clinical and radiological findings.
- Prompt initiation of anti-tuberculous treatment is essential for favorable outcomes in infants with congenital TB.
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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