Congenital Tuberculosis in a Neonate: A Case Report and Literature Review

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.

A Case of Miliary Perinatal Tuberculosis in a Preterm Newborn Infant Presenting as Peritonitis

“…Furthermore, 60%-70% of the mothers had no clinical manifestations of TB and were diagnosed after delivery [10]. Yeh et al reported a 2.2-fold increase in infant mortality in cases where the mothers had subclinical TB [11]. In the most recent analysis of 92 cases of congenital TB, the reported incidence of splenic TB at 12% and to our knowledge, there are only two cases on PubMed cases reports describing tuberculous peritonitis [10,[12][13].…”

A case of early neonate bovine tuberculosis in Ethiopia

“…An animal with a chronic stage of the disease is known to be highly infectious and would likely serve as a good source of infection to a neonate by transmission in several possible ways. 17,18 Whether or not this was the case for the observed dam, it is still likely that her calf got infected in its first week of life, while suckling the colostrum and/or inhalating the aerosol produced by her. Attempt to generate strong evidence to establish transmission from the dam has not been successful due to failure to culture M bovis from the nasal swab sample; resampling of the dam was not possible as the animal was later culled without the knowledge of the authors.…”

A case of early neonate tuberculosis in a three weeks old calf in Ethiopia

“…An animal with a chronic stage of the disease is known to be highly infectious and would likely serve as a good source of infection to a neonate by transmission in several possible ways. 17,18 Therefore, it is highly likely that the calf in this observed case got infected in its first week of life, while suckling the colostrum by inhalation of aerosol primarily generated from its dam, although the possibility of transmission from other infected animals could not be ruled out as all reactors in this farm shared the same housing and husbandry system as the calf. In fact, the latter could explain why strains of the two spoligotype patterns were isolated from its lungs.…”