Miliary tuberculosis with diagnostic challenges in infancy: a case report from Vietnam

Area of Science:

• Pediatrics
• Infectious Diseases
• Microbiology

Background:

• Miliary tuberculosis in infants is a severe, often misdiagnosed condition due to nonspecific symptoms resembling common childhood illnesses like bronchiolitis.
• Microbiological confirmation in paucibacillary pediatric cases is challenging, leading to treatment delays, particularly in high-burden regions like Vietnam.

Purpose of the Study:

• To present a case of infant miliary tuberculosis diagnosed using a nasopharyngeal swab.
• To highlight the potential of nasopharyngeal swabs as a non-invasive diagnostic tool for pediatric miliary tuberculosis.

Main Methods:

• A 3-month-old infant with persistent wheezing unresponsive to bronchiolitis therapy was evaluated.
• Chest CT revealed diffuse miliary nodules and lymphadenopathy.
• Nasopharyngeal swab testing for Mycobacterium tuberculosis using Xpert MTB/RIF assay confirmed rifampicin-sensitive tuberculosis.

Main Results:

• Gastric aspirate samples were negative for tuberculosis.
• Nasopharyngeal swab testing was positive for Mycobacterium tuberculosis.
• The infant showed rapid clinical improvement after initiating a 6-month anti-tuberculosis regimen.

Conclusions:

• Miliary tuberculosis should be considered in infants with persistent wheezing.
• Nasopharyngeal swabs may serve as a valuable non-invasive diagnostic method for pediatric tuberculosis when conventional samples are negative or inaccessible.
• Further research is needed to evaluate the diagnostic yield of nasopharyngeal swabs and investigate the implications of disseminated disease despite vaccination.