Congenital pulmonary tuberculosis

Congenital tuberculosis is a fatal disease in the absence of treatment. The diagnosis is difficult due to polymorphic and nonspecific symptoms in neonates, as well as the lack of alertness of neonatologists and pediatricians. Less than 500 confirmed cases of congenital tuberculosis have been described in the available literature. Mortality ranges from 15 to 33%. Early diagnosis and adequate therapy are essential to improve the prognosis of the disease. Two cases of pulmonary congenital tuberculosis in premature neonates with a positive maternal and familial history of tuberculosis is presented. The clinical symptoms and radiological features started on the days 24 and 48 of life, respectively. Shortness of breath, low blood oxygen level requiring oxygen therapy, fever, and impaired general well-being revealed. The chest X-ray revealed bilateral polysegmental infiltrative lesions with the formation of a cavity of destruction in one case. The diagnosis was established after the detection of M. tuberculosis DNA in gastric aspirates. Patients received therapy according to a regimen designed for multidrug-resistant tuberculosis, including conventional anti-TB drugs in combination with linezolid, fluoroquinolones, meropenem, and aminoglycosides. The infectious syndrome in a premature newborn associated with pneumonia resistant to standard antibiotic therapy, the presence of tuberculosis in the mother, relatives, or siblings require a work-up for the detection of M. tuberculosis and instrumental diagnostics. Early diagnosis and treatment are critical for improving the prognosis of the disease.

1. Kini P.G. Congenital tuberculosis associated with maternal asymptomatic endometrial tuberculosis. Ann Trop Paediatr 2002; 22(2): 179–181. DOI: 10.1179/027249302125000913

2. Patel S., DeSantis E.R. Treatment of congenital tuberculosis. Am J Health Syst Pharm 2008; 65(21): 2027–2031. DOI: 10.2146/ajhp080054

3. Li C., Liu L., Tao Yu. Diagnosis and treatment of congenital tuberculosis: a systematic review of 92 cases. Orphanet J Rare Dis 2019; 14(1):1 31. DOI: 10.1186/s13023–019–1101-x

4. Suliman S., Pelzer P., Shaku M., Rozot V., Mendelsohn S. Meeting report: Virtual Global Forum on Tuberculosis Vaccines, 20–22 April 2021. Vaccine 2021; 39(50): 7223–7229. DOI: 10.1016/j.vaccine.2021.08.094

5. Yeh J., Lin S., Lin W.-S. Congenital Tuberculosis in a Neonate: A Case Report and Literature Review. Front Pediatr 2019; 7: 255. DOI: 10.3389/fped.2019.00255

6. Shao Yu., Hageman J.R., Shulman S.T. Congenital and perinatal tuberculosis. NeoReviews 2021; 22(9): e600–e605. DOI: 10.1542/neo.22–9-e600

7. Marais B.J., Gie R.P., Schaaf H.S., Hesseling A.C., Obihara C.C., Starke J.J. et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis 2004; 8(4): 392–402

8. Cantwell M.F., Shehab Z.M., Costello A.M., Sands L., Green W.F., Ewing E.P. et al. Brief report: congenital tuberculosis. N Engl J Med 1994; 330(15): 1051–1054. DOI: 10.1056/NEJM199404143301505

9. Vogel M., Schroten H., Kahl P., Müller A. High latency of tuberculosis manifestation in a premature extremely low birth weight infant with favorable outcome. Neonatology 2014; 105(2): 91–94. DOI: 10.1159/000355538

10. Şen V., Selimoğlu Ş.H., Aktar F., Uluca Ü., Karabel M., Fuat G.M. Congenital tuberculosis: presentation of a rare case. Arch Argent Pediatr 2015; 113(2): e101–e105. DOI: 10.5546/aap.2015.e101

11. Peng W., Yang J., Liu E. Analysis of 170 cases of congenital TB reported in the literature between 1946 and 2009. Pediatr Pulmonol 2011; 46(12): 1215–1224. DOI: 10.1002/ppul.21490

12. Schaaf H.S., Collins A., Bekker A., Davies P.D. Tuberculosis at extremes of age. Respirology 2010; 15(5): 747–763. DOI: 10.1111/j.1440–1843.2010.01784

13. Slattery S.M., Muller A.J., Alexander K., Hageman J.R. Index of suspicion in the nursery: Neonate with respiratory distress and shock. NeoReviews 2014; 15(10): 458–460 DOI: 10.1542/neo.15–10-e458

14. Aldana-Aguirre J.C., El-Hakim H., Phillipos E., Landry M.A. Congenital tuberculosis presenting as otorrhoea in a preterm infant. BMJ Case Rep 2018; 2018: bcr2017221797. DOI: 10.1136/bcr-2017–221797

15. Mittal H., Das S., Faridi M.M. Management of newborn infant born to mother suffering from tuberculosis: current recommendations & gaps in knowledge. Indian J Med Res 2014; 140(1): 32–39

16. Di Comite A., Esposito S., Villani A., Stronati M.; Italian Pediatric TB Study Group. How to manage neonatal tuberculosis. J Perinatol 2016; 36: 80–85. DOI: 10.1038/jp.2015.99

17. Obringer E., Heald-Sargent T., Hageman J.R. Neonatal tuberculosis. Pediatr Ann 2015; 44(5): e126–e130. DOI: 10.3928/00904481–20150512–12

18. Espiritu N., Aguirre L., Jave O., Sanchez L., Kirwan D.E., Gilman R.H. Congenital transmission of multidrug-resistant tuberculosis. Am J Trop Med Hyg 2014; 91(1): 92–95. DOI: 10.4269/ajtmh.13–0002

19. Naik S., Alexander M., Kumar P., Kulkarni V., Deshpande P., Yadana S. et al. Systemic inflammation in pregnant women with latent tuberculosis. Infect Front Immunol 2021; 11: 587617. DOI: 10.3389/fimmu.2020.587617

20. Lee M.H., Lim G.Y., Chung J.H., Kim S.Y. Disseminated congenital tuberculosis presenting as peritonitis in an infant. Jpn J Radiol 2013; 31(4): 282–285. DOI: 10.1007/s11604–012–0174–4

21. WHO consolidated guidelines on drug-resistant tuberculosis treatment: WHO/2019 [Электронный ресурс]. WHO consolidated guidelines on drug-resistant tuberculosis treatment. Ссылка активна на 12.12.2022 г

22. Singh V. Pediatric TB Management under RNTCP: What and Why?. Indian J Pediatr 2019; 86: 707–713. DOI: 10.1007/S12098–019–03001–7

23. Tuberculosis in children. Clinical recommendations of the Ministry of Health of Russia, 2020, ID 507. Electronic version. (in Russ.)

24. Ahmad N., Ahuja S.D., Akkerman O.W., Alffenaar J.C., Anderson L.F., Baghaei P. et al. Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment–2017. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet 2018; 392(10150): 821–834. DOI: 10.1016/S0140–6736(18)31644–1

25. Thee S., Garcia-Prats A.J., Donald P.R., Hesseling A.C., Schaaf H.S. Fluoroquinolones for the treatment of tuberculosis in children. Tuberculosis (Edinb) 2015; 95(3): 229–245. DOI: 10.1016/j.tube.2015.02.037