A 20 day old male infant presented with fever, respiratory distress and poor feeding for 7 days. He
was referred from a community hospital and diagnosed as sepsis. Physical examination revealed
hepatosplenomegaly. A chest radiograph showed miliary infiltration of both lungs. Smear of gastric washing
for AFB was positive. Congenital tuberculosis was diagnosed, the infant was successfully treated with
antituberculous drugs and followed up monthly for 1 year. He had good health and normal development after
the illness.
Discussion
Tuberculosis in the neonate can be either
congenital (ie, acquired in utero) or neonatal (ie,
Fig. 1 CXR reveals diffuse bilateral interstitial infiltration acquired early in life from mother or contagious
of both lungs member). Hematogenous spread and aspiration of
infected amniotic fluid account for approximately half
drugs (INH, Rifampicin, PZA, Streptomycin) were the cases of congenital tuberculosis each(4,5). In
started. Cefotaxime was also administered for 14 days, neonatal tuberculosis, infants can be acquired by
beginning on admission. One week after treatment, inhalation or ingestion of infected droplet or by
he developed jaundice, LFT showed elevation of contamination of traumatized skin or mucous
bilirubin and liver enzymes; total bilirubin/direct membranes. It is not always possible to be sure of the
bilirubin = 18.6/14.9, SGOT = 120 and SGPT = 79. route of infection in a particular neonate, and with
Vitamin K 1 mg. was administered intravenous route. effective chemotherapy, it is not essential for the care
Rifampicin and PZA were discontinued and jaundice of the infant. However, it is important to try to identify
improved in 1 week. the source of infection so that the person infecting
Ciprofloxacin was substituted for rifampicin the infant can be treated and further transmission can
and the patient responded well to therapy. He was be prevented.
discharged on day 35 of admission. The patient was In 1935, Beitzke(6) suggested criteria for
followed up monthly thereafter without exacerbation diagnosis of congenital tuberculosis. These criteria
of his tuberculosis. His hepatosplenomegaly persisted include confirmation of TB in the infant and one of
and ultrasound abdomen at 10 months of age showed the following; lesions in the first few days of life,
multiple calcifications at liver and spleen (Fig. 2). After demonstration of a primary hepatic complex, or
treatment with anti TB drugs for 1 year (2ICS/10 IC), exclusion of postnatal exposure by separation of the
CXR showed clearing of miliary lesions in the lung. infant from mother at birth. Beitzke criteria have
become difficult to apply in clinical practice because Table 1. Most Frequent Signs and Symptoms of Congenital
it must demonstrate the primary hepatic complex by Tuberculosis
surgical procedure or autopsy to confirm liver and
Symptom or Sign Frequency (%)
regional lymph node involvement, in contrast with liver
biopsy to demonstrate caseating hepatic granuloma Hepatosplenomegaly* 76
which is more simplified. In addition, the infant must Respiratory distress* 72
be separated from the mother at birth rather than a Fever* 48
thorough investigation of contacts. So in 1994, Lymphadenopathy 38
Abdominal distention 24
Cantwell et al(4) proposed the following revised Lethargy or Irritability* 21
diagnostic criteria; the infant must have a proven Ear discharge 17
tuberculous lesion and at least one of the following; Papular skin lesions 14
1) lesion in the first week of life 2) a primary hepatic Vomiting, Apnea, Cyanosis, < 10 each
complex or caseating hepatic granulomas 3) Jaundice, Seizure, Petichiae
tuberculosis infection of the placenta or maternal * symptoms or signs found in the presented patient
, ,
20
7
miliary infiltration 2 AFB
1