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Congenital Tuberculosis and Management of Exposures in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Brent W. Laartz ,
Hugo J. Narvarte ,
Douglas Holt ,
Julie A. Larkin  and
William F. Pomputius III
Brent W. Laartz*
Affiliation:
Division of Infectious Diseases, University of South Florida, Tampa Children's Hospital, Tampa, Florida
Hugo J. Narvarte
Affiliation:
Department of Internal Medicine/Pediatrics, Baylor Univesity, Houston, Texas
Douglas Holt
Affiliation:
Division of Infectious Diseases, University of South Florida, Tampa Children's Hospital, Tampa, Florida Hillsborough County Department of Public Health, Tampa Children's Hospital, Tampa, Florida
Julie A. Larkin
Affiliation:
Infectious Disease Associates, Sarasota, Florida
William F. Pomputius III
Affiliation:
Division of Pediatric Infectious Diseases, Tampa Children's Hospital, Tampa, Florida
*
Division of Infectious Diseases, University of South Florida, Tampa General Healthcare, Tampa, FL 33601-1289
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Abstract

Objective:

We report a case of congenital tuberculosis in a neonatal intensive care unit (NICU) and the management of exposure to other neonates in the hospital. We review the literature regarding congenital tuberculosis and management of exposures in the NICU.

Design:

Case report and a survey of exposures with a 3-month follow-up.

Setting:

Urban hospital.

Patients:

Neonates exposed to a case of congenital tuberculosis.

Interventions:

Exposure to tuberculosis was treated with isoniazid. Purified protein derivative tests were placed at base-line and 3 to 4 months after exposure. Chest radiographs were performed if clinically indicated.

Results:

Congenital tuberculosis was diagnosed in our patient at 21 days of age during a prolonged hospital course. After initiation of anti-tuberculous medications, the patient gradually recovered from his illness. While he was treated in the NICU, there were 37 potentially exposed infants. Of these, 36 were administered tuberculin skin tests (average age, 1.7 months), all of which were read as 0 mm of induration. Of those 37, 35 began prophylaxis with isoniazid, and 30 were able to complete treatment with a minimum of 3 months of isoniazid therapy. Of those 30, two infants received 6 months of therapy. Additionally, 29 of the 37 infants had chest radiographs, none of which showed suspicious infiltrates or adenopathy. Finally, 30 of the 36 infants had repeat tuberculin skin tests at 3 months, all of which were read as 0 mm of induration (average age, 3.7 months).

Conclusion:

Congenital tuberculosis is an uncommon disease that requires early diagnosis for successful therapy and vigilant follow-up of potential exposures in the NICU. (Infect Control Hosp Epidemiol 2002;23:573-579).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 10 , October 2002 , pp. 573 - 579
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Centers for Disease Control and Prevention. Progress towards the elimination of tuberculosis: United States, 1998. MMWR 1999;48:732–736.Google Scholar
2.Raviglione, MC, Snider, DE Jr, Kochi, A. A global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA 1995;273:220–226.Google Scholar
3.Snider, DE, Bloch, AB. Congenital tuberculosis. Tubercle 1984;65:81–82.Google Scholar
4.Corner, B, Brown, NJ. Congenital tuberculosis: report of a case with necropsy findings in mother and child. Thorax 1955;10:99–103.Google Scholar
5.Cantwell, MF, Shehab, ZM, Costello, AM Jr, et alCongenital tuberculosis. N Engl J Med 1994;330:1051–1054.Google Scholar
6.Hageman, J, Shulman, S, Schreiber, M, Luck, S, Yogev, R. Congenital tuberculosis: critical reappraisal of clinical findings and diagnostic procedures. Pediatrics 1980;66:980–984.Google Scholar
7.Abughali, N, Van der Kuyp, F, Annable, W, Kumar, M. Congenital tuberculosis. Pediatr Infect Dis J 1994;13:738–741.Google Scholar
8.Ng, PC, Hiu, J, Fok, TF, Nelson, EAS, Cheung, KL, Wong, W. Isolated congenital tuberculous otitis in a preterm infant. Acta Pediatr 1995;84:955–956.CrossRefGoogle Scholar
9.Senbil, N, Sahin, F, Caglar, MK, Oksal, A, Yilmaz, F, Tuna, F. Congenital tuberculosis of the ear and parotid gland. Pediatr Infect Dis J 1997;16:1090–1091.CrossRefGoogle ScholarPubMed
10.Popli, MB, Mehta, N, Nijhavan, VS, Popli, V. Congenital tuberculosis. Australas Radiol 1998;42:256–257.Google Scholar
11.Lee, LH, LeVea, CM, Graman, PS. Congenital tuberculosis in a neonatal intensive care unit case report, epidemiological investigation, and a management of exposures. Clin Infect Dis 1998;27:474–477.CrossRefGoogle Scholar
12.Adhikari, M, Pillay, T, Pillay, DG. Tuberculosis in the newborn: an emerging disease. Pediatr Infect Dis J 1997;16:1108–1112.Google Scholar
13.Chen, S. Maternal and fetal infection with Mycobacterium tuberculosis. Arch Dis Child Fetal Neonatal Ed 1997;77:77F–88F.Google Scholar
14.Spark, RP, Pock, NA, Pedron, SL, Fox, C, Opulski, A. Perinatal tuberculosis and its public health impact a case report. Tex Med 1996;92:50–53.Google Scholar
15.Loeffler, AM, Milstein, JM, Kosh, DL. Fever, hepatosplenomegaly, and rash in a newborn. Pediatr Infect Dis J 1996;15:721–724.Google Scholar
16.Vucicevic, Z, Suskovic, T, Ferencic, Z. A female patient with tuberculous polyserositis, and congenital tuberculosis in her newborn child. Tuber Lung Dis 1995;76:460–462.Google Scholar
17.Matthai, J, Ravikumar, VR, Ramaswamy, M. Congenital tuberculosis: under diagnosed or under reported? Indian J Pediatr 1994;61:430–432.Google Scholar
18.Verma, M, Chhatwal, J, Sarin, YK, Singh, VP, Singh, T, Aneja, R. Congenital tuberculosis: an underdiagnosed entity. Indian Pediatr 1996;33:51–54.Google Scholar
19.American Academy of Pediatrics. Tuberculosis. In: Pickering, LK, ed. 1996 Red Book: Report of the Committee on Infectious Diseases, 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1996:609–610.Google Scholar
20.Light, IJ, Saidleman, M, Sutherland, JM. Management of newborns after nursery exposure to tuberculosis. American Review of Respiratory Disease 1974;109:415–419.Google Scholar
21.Steiner, P, Rao, M, Victoria, MS, Rudolph, N, Buynoski, G. Miliary tuberculosis in two infants after nursery exposure: epidemiologic, clinical, and laboratory findings. American Review of Respiratory Disease 1976; 113:267–271.Google Scholar
22.Burk, JR, Bahar, D, Wolf, FS, Greene, J, Bailey, WC. Nursery exposure of 528 newborns to a nurse with pulmonary tuberculosis. South Med J 1978;71:7–10.Google Scholar
23.Myers, JP, Perstein, PH, Light, IJ, Towbin, RB, Dinscoy, HP, Dinscoy, MY. Tuberculosis in pregnancy with fatal congenital infection. Pediatrics 1981;67:89–94.Google Scholar
24.Centers for Disease Control and Prevention. Core Curriculum on Tuberculosis, 4th ed. Atlanta, GA: Centers for Disease Control and Prevention; 2000:55.Google Scholar