Congenital and Perinatal Tuberculosis

Abstract

This review discusses the recent literature (2006–2020) about the epidemiology, clinical presentation, diagnosis, and management of infants with congenital or perinatal tuberculosis (TB). While the incidence of childhood TB is declining in the United States and worldwide, many case reports describe how clinical suspicion for neonatal TB is raised only if an ill-appearing neonate does not improve with broad-spectrum antibiotics. Furthermore, the delay in initiating appropriate anti-TB therapy often results in the need for significant cardiopulmonary support and/or an increase in mortality. This review summarizes important clinical indications in the maternal and newborn history, the evaluation of an infant with possible TB exposure, and step-by-step recommendations for the treatment and follow-up of infants with TB.

A case of community-acquired tuberculosis in an infant presenting with pneumonia refractory to antibiotic therapy

“…Vertical transmission from mother to neonate is also possible. 4 Interestingly, a meta-analysis of studies from 1929-2015 found that <20% of TB transmission to children was attributable to household exposures, suggesting that community exposure may be more substantial than previously considered, consistent with the mode of acquisition in this case. 5 Since pulmonary TB may be difficult to distinguish from community-acquired pneumonia, results of a recent retrospective cohort study in South Korea proposed that a delta neutrophil index (>1.0%) may be useful to rule out the possibility of pulmonary TB given its high negative predictive value, but its utility is dependent on regional prevalence.…”

“…Chest radiography in infant TB may reveal miliary pattern (47%), multiple pulmonary nodules (11%), and lobar pneumonia (12%). 4 Patients with a miliary pattern should be evaluated for meningitis and intracranial disease. Analysis of CSF usually demonstrates lymphocytosis, low glucose, and high protein concentrations, though CNS involvement with negative CSF studies was previously reported.…”

Diagnosis and Surveillance of Neonatal Infections by Metagenomic Next-Generation Sequencing

“…Fetus infected with Mycobacterium tuberculosis intrauterine or during delivery is called congenital tuberculosis, which is a rare type but might leader to a high mortality rate ( Jenkins et al, 2017 ). Literature reviewed reported no more than 400 cases in world limited treatment experience with M. tuberculosis infection ( Newberry and Robertson Bell, 2018 ; Li et al, 2019 ; Shao et al, 2021 ). Congenital tuberculosis symptoms cover respiratory, neurologic, and gastrointestinal.…”

Imaging recommendations and algorithms for pediatric tuberculosis: part 1—thoracic tuberculosis

“…Congenital TB is an extremely rare M ycobacterium tuberculosis infection transmitted from the mother to the fetus [ 44 ] with only 300–400 reported cases [ 45 , 46 ]. Chest radiographs may be normal initially [ 44 – 48 ]. The most common reported findings which may appear after 4–8 weeks are miliary pattern, multiple pulmonary nodules, lobar pneumonia and rarely, bronchopneumonia, interstitial pneumonia and mediastinal lymphadenopathy [ 45 , 46 , 48 ].…”

“…Chest radiographs may be normal initially [ 44 – 48 ]. The most common reported findings which may appear after 4–8 weeks are miliary pattern, multiple pulmonary nodules, lobar pneumonia and rarely, bronchopneumonia, interstitial pneumonia and mediastinal lymphadenopathy [ 45 , 46 , 48 ]. Ultrasound may show hypoechoic foci in the liver or spleen, ascites and abdominal lymphadenopathy.…”