Successful Isolation and Treatment of Cogenital Tuberculosis Infection Occurred in Premature Infants in the Neonatal Intensive Care Unit

Susie Yoo; Sang Hoon Chun; Jacob Lee; Tae-Jung Sung

doi:10.14734/PN.2017.28.3.92

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Yoo, Chun, Lee, and Sung: Successful Isolation and Treatment of Cogenital Tuberculosis Infection Occurred in Premature Infants in the Neonatal Intensive Care Unit

Case report

Perinatology 2017;28(3):92-95.

Published online: 19 September 2017

DOI: https://doi.org/10.14734/PN.2017.28.3.92

Successful Isolation and Treatment of Cogenital Tuberculosis Infection Occurred in Premature Infants in the Neonatal Intensive Care Unit

Susie Yoo, MD¹, Sang Hoon Chun, MD¹, Jacob Lee, MD², Tae-Jung Sung, MD, PhD^1,

¹Department of Pediatric, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea

²Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea

Correspondence to Tae-Jung Sung, MD, PhD Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-829-5142 Fax: +82-2-849-4469, E-mail: neosung@hallym.or.kr

Received 2 June 20177 July 2017 Accepted 26 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Congenital tuberculosis is a very rare disease and the affected infants are often delivered prematurely. Even though proper treatment, the mortality rate is high. The preterm male infant born at 24 weeks of gestational age with birth weight of 760 g was admitted to neonatal intensive care unit (NICU) for intensive treatment. One month after delivery, his mother visited to outpatient clinic for headache and nausea and later she was diagnosed with tuberculous meningitis. Then, the preterm infant who was already hospitalized was examined for the possibility of congenital infection. As a result, congenital tuberculosis infection was confirmed by positive reaction with tuberculosis in acidfast bacilli stain, culture and polymerase chain reaction. The infant was completely isolated for 2 weeks and antituberculosis drugs were administrated. We performed chest radiography and skin reaction test for the other 29 infants and 60 co-workers in the NICU during the same period. The infants were treated with prophylactic antituberculous drug. Three months later, no abnormal findings were observed in any infants and any co-workers during the follow up period. We report the experience of successful treatment and isolation for congenital tuberculosis in premature infants.

Keywords: Tuberculosis, Premature infant, Intensive care units, Newborn, Prevention

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Fig. 1

Chest x-ray of infant. (A) Chest X-ray at hospital day 1 showed suspicious of respiratory distress syndrome. (B) Chest X-ray at hospital day 40 taken when the infant's mother diagnosed with tuberculosis meningitis. (C) Chest x-ray at hospital day 140 showed bronchopulmonary dysplasia.

Fig. 2

Chest computed tomography of the infants taken before discharge, i.e., hospital days of 138. Several linear atelectasis in both lungs was shown in mostly dependent portion.

Table 1.

Culture and PCR Results of Mother and Her Baby

	Infant		Mother
	Initial BAL	2 weeks after treatment	Initial CSF	1 month aftertreatment CSF, sputum
AFB culture	M. tuberculosis	No growth AFB	M. tuberculos	No growth AFB
TB PCR	Positive	Negative	Negative	Negative
NTM PCR	Negative	Negative	Negative	Negative

Abbreviations: BAL, bronchoalveolar lavage; CSF, cerebrospinal fluid; AFB, acidfast bacilli; TB, tuberculosis; NTM, non-tuberculous mycobacteria; PCR, polymerase chain reaction.

Table 2.

Results of Antimicrobial Drug Susceptibility Test of Affected Infant

Name	Absolute concentration	Susceptibility
INH	0.2	S
RMP	40.0	S
SM	10.0	S
EMB	2.0	S
KM	40.0	S
RBT	20.0	S
AMK	40.0	S
TH	40.0	S
CS	30.0	S
OFLX	2.0	S
PAS	1.0	S
CPM	40.0	S
MXF	2.0	S
LFX	2.0	S

Abbreviations: INH, isoniazid; RMP, rifampicin; SM, streptomycin; EMB, ethambutol; KM, kanamycin; RBT, rifabutin; AMK, amikacin; TH, ethionamide; CS, cycloserine; OFLX, ofloxacin; PAS, para-aminosalicylic acid; CPM, capreomycin; MXF, moxifloxacin; LFX, levofloxacin.

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