Disseminated Tuberculosis With Cavitary Lung Disease in a Very Preterm Infant

Tuberculosis (TB) is an important cause of poor health outcomes and mortality for pregnant women and their infants globally. Screening during pregnancy helps diagnose TB at a critical period to avert morbidity and mortality but may be overlooked. TB incidence in the United States is low but has been increasing since 2020, alongside a global resurgence. The Centers for Disease Control and Prevention (CDC) recommends TB screening for all individuals with epidemiologic risk factors, including birth, residence, or prolonged travel in medium- or high-prevalence settings; immunosuppression; and close contact with individuals with TB disease. Careful attention is needed to discern possible TB disease in individuals with compatible symptoms, which are often nonspecific and can be initially subtle in pregnant women and in infants. We describe a mother-infant dyad who both developed severe disseminated TB, with likely congenital transmission to the infant. The infant was born very preterm and developed severe TB characterized by cavitary lung disease and central nervous system involvement. Delayed recognition of TB risk and symptoms in both the mother and the infant contributed to delayed diagnosis and treatment initiation. We discuss opportunities for timely perinatal TB diagnosis and care through antenatal screening, careful assessment of TB symptoms and signs, and prompt anti-tuberculous treatment initiation as soon as the diagnosis is suspected. The severe outcomes in this case highlight the importance of perinatal TB awareness in the United States.