Congenital Pulmonary Tuberculosis Associated With Maternal Cerebral Tuberculosis, Florida, 2002

Main Category: Tuberculosis
Also Included In: Pediatrics / Children's Health
Article Date: 21 Mar 2005 - 0:00 PST

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In 2002, congenital tuberculosis (TB), a rare disease with nonspecific signs and symptoms, was diagnosed in an infant in Florida. If untreated, congenital TB is fatal, which underscores the importance of suspecting congenital TB in newborns and infants who are at risk and who have unexplained febrile illnesses (1). This report summarizes the investigation of the case in Florida. Health-care practitioners should administer a tuberculin skin test to women who have risks for Mycobacterium tuberculosis infection and treat those who have latent TB infection (LTBI) to prevent maternal and congenital TB disease (2).

In May 2002, a U.S.-born male infant aged 44 days was brought to hospital A after 3 days of respiratory distress and fever. Examination revealed a fever of 103.2�F (39.6�C), nasal congestion, and bibasilar wheezing. The neck was supple, and no superficial lymphadenopathy was palpable. The abdomen was soft, no hepatosplenomegaly was detected, and ultrasound images of the liver were normal. The chest radiograph showed left lower lobe infiltrates, and the infant was admitted to the hospital for presumptive bacterial pneumonia. The fever continued despite administration of broad-spectrum antibiotics; on hospital day 9, physicians learned that the mother had cerebral TB diagnosed at hospital B approximately 20 days earlier. Gastric aspirates and bronchial washings from the infant yielded acid-fast bacilli (AFB) on smear microscopy and M. tuberculosis by rRNA amplification (Amplified� Mycobacterium Tuberculosis Direct Test, Gen-Probe, San Diego, California) and by culture. Serology results for human immunodeficiency virus (HIV) antibody were negative. The infant subsequently was administered isoniazid, rifampin, pyrazinamide, and streptomycin. The streptomycin was discontinued when drug-susceptibility studies showed resistance to it. The infant responded favorably to treatment and was discharged after 8 weeks in hospital A. Investigation of potential sources of M. tuberculosis infection other than the mother (i.e., the father, a grandmother, and hospital staff) did not reveal any additional cases of TB disease.

The mother, aged 30 years, was born in Haiti, where TB is prevalent, and had moved to the United States in 1995; she had no children previously. After an uneventful pregnancy, during which she received prenatal care and had negative serology results for HIV antibody, the mother reported having a seizure 1 week before delivery; however, she did not seek medical care. The baby was born at hospital A at full term, with 1-minute and 5-minute Apgar scores of 6 and 9, respectively (normal: 7--10 at 5 minutes), clear amniotic fluid, and a grossly normal placenta. The mother began breastfeeding without difficulty and had no signs or symptoms of mastitis. From the day after delivery, she felt feverish; 3 days later, she had seizures lasting 15 minutes. She was admitted to hospital B, and magnetic resonance imaging showed five inflammatory cortical brain lesions. Histology of a brain biopsy specimen from the mother, obtained 10 days before her infant was admitted to hospital A with respiratory distress and fever, revealed necrotic granulomata and AFB. Cerebrospinal fluid from a lumbar puncture had no white blood cells and normal concentrations of glucose and protein; the results of Gram stain and culture (not performed for mycobacteria) were negative. Culture of her brain tissue yielded M. tuberculosis susceptible to isoniazid, rifampin, and pyrazinamide but resistant to streptomycin. A chest radiograph was normal; the results of AFB smear and culture on the mother's sputum were negative. The uterus was not curetted. The mother recovered fully while receiving isoniazid, rifampin, pyrazinamide, and the anticonvulsant oxcarbazepine. M. tuberculosis isolates from mother and infant were subsequently determined to have identical genotype patterns by IS6110-based restriction fragment length polymorphism.

Two years before her pregnancy, the mother had been administered a preemployment tuberculin skin test with a positive result of 20 mm of induration (>10 mm is positive for persons from countries with high incidence of TB). A chest radiograph was normal, and treatment for LTBI was not prescribed at that time�. CONTINUES�.cdc.gov/mmwr

Reported by: B Naouri, MD, V Virkud, MD, J Malecki, MD, Palm Beach County Health Dept; J Mateo, MD, Saint Mary's Medical Center, West Palm Beach; M Narita, MD, D Ashkin, MD, H Duncan, MPH, Bur of Tuberculosis and Refugee Health, Florida Dept of Health.