Congenital Tuberculosis in an Integrated Healthcare System

Abstract

ISSUE: Congenital tuberculosis (TB) is a rare, but devastating, perinatal event. Congenital TB is transmitted from a mother with acute primary, miliary, endometrial, or cervical disease. The infant presents between 2 and 4 weeks of age with hepatosplenomegaly and respiratory symptoms. Congenital TB may be the first indication of maternal TB. A 2-week-old Hispanic infant presented to the Emergency Department with abdominal distention and fussiness. He was diagnosed with congenital miliary TB, affecting his liver and lungs. The mother had received prenatal care and had a negative tuberculin skin test (TST) at 10 weeks. After her infant's diagnosis, she was found to have a TST of 20 millimeters. A chest radiograph showed a pleural effusion. Although pleural fluid, sputum cultures, and an endometrial biopsy were negative for TB, she was treated for TB disease. PROJECT: The Infection Control and Infectious Disease Departments reviewed this case to determine if any additional interventions could have prevented this outcome. RESULTS: Case review showed that the clinical presentation in the mother was suggestive of primary TB. During such an infection, although the TST may be initially negative, the mother may have hematogenous dissemination of TB. This may have led to the congenital TB. LESSONS LEARNED: TST during pregnancy may help identify mothers with active or latent TB infection. However, a negative TST during the prenatal period does not preclude the subsequent occurrence of congenital TB.