Neonatal Tuberculosis

Abstract

Tuberculosis remains a prevalent disease worldwide, with approximately 9 million cases diagnosed annually. The emergence of multidrug-resistant tuberculosis has proven to be a challenging international public health issue. In the United States, however, the incidence of tuberculosis has been decreasing since 1992. There were just over 9,500 reported cases in 2013, and almost 500 of those were in children younger than age 15 years. Foreign-born persons are a high-risk group and account for 65% of new cases annually. Other high-risk groups include ethnic minorities, HIV-infected patients, and people living in low-socioeconomic urban areas.

A Perspective of the Diagnosis and Management of Congenital Tuberculosis

“…Before penetrating to the infant's liver or lungs to form a primary tuberculous complex, bacilli cross the placenta through the umbilical vein, and a primary focus develops in the fetal liver with involvement of the periportal lymph nodes and the bacilli infect secondarily the lung. Therefore it is a hematogenous infection, and hence it is called congenital infection by vertical contamination of TB [9–11]. Otherwise, the neonate may acquire the disease in utero or in intrapartum and/or at childbirth through aspiration or inhalation or ingestion of infected amniotic fluid causing primary infection of fetal lungs and gut or via direct contact with the infected maternal genital tract.…”

“…Liver or lymph node biopsy may be undertaken for histology and culture but it remains highly invasive method for neonate. Moreover, early morning gastric aspirates to infants with pulmonary illnesses have a 75% positive yield, which is remarkably higher than older children [9]. Standard workup is less efficient in investigation for TB for neonate, such as complete blood count, C-reactive protein, erythrocyte sedimentation rate, liver function tests, and chest radiograph which may also be imperative and informative.…”

“…However, at the time of diagnosis of the newborn, most of mothers are unmindful of their infection [9]. Accordingly, if the disease is suspected in the mother then screening and investigation of the mother for TB are paramount.…”

“…However, several therapeutic regimens have been assessed and established. In that case, newborns suffering from pulmonary and extrapulmonary disease should undergo a regimen of four drugs like older children and adults with active disease until sensitiveness is known [4, 9]. …”

“…In the instances of more severe presentation such as tuberculosis meningitis and endobronchial and miliary disease, corticosteroids are recommended. Supportive therapy such as oxygen may be nevertheless required [4, 9]. An essential element of treatment is the close observance of regularity and duration of treatment.…”