Nosocomial Transmission of Congenital Tuberculosis in a Neonatal Intensive Care Unit

Abstract

Congenital tuberculosis is uncommon, and nosocomial transmission from a congenitally infected infant to another infant has not been reported in the English literature. We report an investigation of 2 infants with tuberculosis who were cared for in the same neonatal intensive care unit. Isolates from both infants were genetically indistinguishable. Transmission between the 2 infants was likely due to contaminated respiratory equipment.

Congenital tuberculosis in premature twins after in vitro fertilisation

“…The incidence of congenital tuberculosis in women of reproductive age group in countries where the disease is endemic is estimated at 2%,1 with approximately 340 cases described in the literature 2. Diagnosis of congenital tuberculosis is difficult due to non-specific symptoms, and a high index of suspicion is required for early diagnosis in infants in order to reduce mortality.…”

Screening following exposure to congenital tuberculosis in a neonatal nursery

“…6 Congenital TB is a rare condition, with only around 340 cases reported in the literature. 4,5 This case met the criteria for congenital TB defined by Cantwell et al 7 given that the infant had tuberculous lesions in early life, his mother had documented granulomata in the endometrium and immediate follow up confirmed the parents and other close contacts did not have active pulmonary disease. 5,7 Setting Monash Newborn is the neonatal intensive care and special care nursery at Monash Medical Centre.…”

“…Airborne precautions are recommended for infants with sputum smears positive for acid-fast bacilli. [1][2][3][4] Although rare, there are reports in the literature of healthcare workers with tuberculin skin test (TST) conversions after providing care to infants with congenital TB. 1,3 This report describes a case of congenital TB in a premature infant in a neonatal intensive care unit and focuses on the subsequent follow up of infants, families and staff contacts.…”

How to manage neonatal tuberculosis

“…If oral treatment is not tolerated, or cannot be administered (because of the patient's critical clinical condition, or in the case of premature newborns and/or newborns with a very lowbirth weight), the intravenous use of isoniazid 15 mg kg − 1 day − 1 has been reported, 20 as has been the use of rifampicin 10-20 mg kg − 1 once or twice a day. 24,25,26 It is important to remember that, in order to avoid the risk of peripheral neuropathy, breast-fed newborns treated with isoniazid should also receive pyridoxine supplementation at a dose of 1 mg kg − 1 day − 1 . 2,18…”