Congenital tuberculosis presenting as sepsis syndrome: case report and review of the literature

Abstract

We report an infant with congenital tuberculosis who presented with fulminant septic shock, disseminated intravascular coagulation and respiratory failure. Aggressive resuscitation and supportive care and prompt initiation of antituberculosis medications led to resolution of the shock state. We reviewed six other cases with a similar presentation. Congenital tuberculosis should be in the differential of the infant presenting acutely with sepsis syndrome.

Congenital Tuberculosis because of Misdiagnosed Maternal Pulmonary Tuberculosis during Pregnancy

“…In our case, consistent with previous reports (11,12), the infant presented at the age of 18 days with hepatomegaly, lethargy, and poor feeding, which are 3 of 5 common clinical manifestations from recent reviews (65.6z, 39.7z, and 39.1z, respectively), whereas the other two common presentations are fever and respiratory distress (64.4z and 63.8z respectively). Moreover, in our case, the clinical manifestations were not improved after antibiotic administration, and, in general, preterm infants have a significantly higher mortality rate compared with term infants (5).…”

Mother to Child Transmission of Tuberculosis, a Problem in Resource Limited Settings under Reported or Undiagnosed - A Case Report

“…Transmission can be hematological through the placenta, via the umbilical vein, with primary lesions occurring in the liver Transmission can also occur as a result of aspiration and or ingestion of infected amniotic or cervicovaginal secretions in utero or during delivery (intrapartum) with resultant pulmonary and or gastrointestinal disease. Transmission more likely if: Mother has miliary, untreated, diagnosed late in pregnancy or post-delivery and has sputum positive TB [9].…”

“…In high HIV prevalent settings mother to child Tuberculosis transmission has been reported [1][2][3][4][5][6][7][8][9]. In Zimbabwe we report a case of a newborn diagnosed with Congenital Tuberculosis whose mother was not infected with HIV.…”

Tuberculosis congénita asociada con tuberculosis materna miliar diseminada

“…La bacteriemia tuberculosa que ocurre durante el embarazo puede resultar en infección de la placenta o del aparato genital materno (24). Esta infección puede ser transmitida al feto por dos mecanismos: 1) a partir de la ruptura de un tubérculo de la placenta ocurre diseminación hematógena por vía del cordón umbilical, que ocasiona un complejo primario en el hígado o en el pulmón (25,26); 2) a partir de una afección de los genitales de la madre (figura 1) ocurre aspiración o deglución de líquido amniótico o sangre infectados, que ocasiona la formación del complejo primario en el pulmón con compromiso de los ganglios mediastinales, o en el intestino con compromiso de los ganglios mesentéricos (25,26).…”