Neonatal tuberculosis
From IDWiki
Background
- Infection of a neonate by Mycobacterium tuberculosis
Pathophysiology
- May be either acquired antenatally as congenital tuberculosis, via hematogenous dissemination from a mother with either miliary or primary TB, or post-natally as neonatal tuberculosis, via the usual airborne mechanism
Clinical Manifestations
- Similar presentation for both congenital and neonatal tuberculosis
- Symptoms may take 1 to 2 weeks to develop (congenital) or several months (neonatal)
- Hepatomegaly, splenomegaly, respiratory distress, fever, lymphadenopathy, abdominal distension, lethargy, irritability, poor feeding and ear discharge
- Congenital TB may also have low birth weight
- Miliary or nodular pattern with hilar lymphadenopathy on chest x-ray
Differential Diagnosis
- Symptoms at birth
- Congenital TORCH infection (toxoplasmosis, rubella, cytomegalovirus, herpes, etc.)
- Congenital syphilis
- Hemophagocytic lymphohistiocytoysis (HLH)
- Presentation after several weeks
- Late-onset bacterial infection
Diagnosis
- Can be difficult if mother does not have a history of TB
- Based on chest x-ray plus clinical picture
- TST and IGRA are typically negative in neonatal period
- Send sputum or gastric aspirates for smear and culture ± PCR
- Can also send ascitic or pleural fluid, or blood, as indicated
- Newborns with suspected or proven disseminated TB need lumbar puncture
- Placental histopathology and culture, if possible
Management
- Treat empirically
- Standard treatment with isoniazid 10 mg/kg po daily, rifampin 15 mg/kg po daily, pyrazinamide 35 mg/kg po daily, and ethambutol 20 mg/kg po daily for 2 months, followed by isoniazid and rifampin alone for another 4 months
- If low prevalence of isoniazid resistance and disease is not extensive, no need for ethambutol during initial treatment
- There are specific treatment considerations for drug-resistant tuberculosis and tuberculous meningitis
