Neonatal Tuberculosis

We present an autopsy case of neonatal miliary tuberculosis in a 36-day-old baby that was born to a mother who had no symptoms. Histopathological examination of lungs revealed necrosis and numerous acid-fast bacilli. Mycobacterium tuberculosis hominis was isolated by guinea pig inoculation with lung tissue. Three months after delivery the mother was admitted with pleural effusion and endometrial biopsy showed a granulomatous inflammation compatible with tuberculosis. Intrauterine infection was considered and that was supported by retrospective findings of the endometrial biopsy. We also want to emphasize the importance of searching for genital tuberculosis even if the mother has no symptoms.     

Esophageal tuberculosis

Esophageal tuberculosis is a rare clinical entity even in adults. Esophageal tuberculosis, can be either primary or secondary, the former is less common as compared to the latter. The authors present a 14-year-old boy, who presented with vomiting, cough, low-grade fever and anorexia for two months. He had a positive mantoux with history of contact to Tuberculosis. Upper Gl scopy revealed an irregular ulcer in the mid esophagus and the biopsy was suggestive of tuberculosis. The CT scan of the chest showed consolidation left lower lobe with hilar and mediastinal adenopathy. He responded well to ATT.     

Mycobacterium tuberculosis transmission among high school students in Greece

BACKGROUND: The aim of this study was to investigate the requirements and practical steps for screening of Mycobacterium tuberculosis (MTB) transmission among high school student populations in two regional high schools of central Greece. Case-matched control populations from other regional schools were included. METHODS: Case study of two indexed cases, 61 close contacts, 212 casual contacts and 369 controls were investigated. Detailed questionnaires, tuberculin-skin test (PPD test), chest radiography, medical evaluation and DNA fingerprinting of sputum isolates were used. RESULTS: In case A, three (1.97%) of 152 close and casual contacts developed tuberculosis, and a further 25 (16.4%) were classified as infected. In contrast, none of the 121 close or casual contacts investigated for Case B developed tuberculosis or were classified as infected. None of the control populations contained infected individuals. Contacts of case A had a much higher risk (3.08 < RR = 22.29 < 161.69, P < 0.001) of being infected than contacts of case B. Two different strains of MTB were found responsible for these outbreaks. CONCLUSION: There was a considerable difference in the infectivity of the two cases presumably due to environmental and clinical factors, although two different MTB strains were responsible. It is proposed that the extent of case investigation should be individualized with particular emphasis placed among close contacts.     

Effect of BCG vaccine on tuberculin skin tests in 1-6-year-old children

Bacillus Calmette Guerin (BCG) vaccination used in the prevention of tuberculosis may cause problems in interpreting the tuberculin skin test (TST), which is commonly used in the diagnosis of infection. A limited number of studies have been undertaken to investigate how length of time after BCG vaccination affects TST results. TST induration values of unvaccinated children were compared with those of children vaccinated once in order to determine the changes in TST responses after BCG vaccination. Mantoux TSTs were administered to 1145 children aged 1-6 y and induration was measured at 72 h. BCG scar status and average TST induration diameters were identified for each age group. CONCLUSION: Average TST induration in vaccinated children is significantly higher than that in unvaccinated children, and in the vaccinated group there is no statistically significant difference between induration values in the different age groups. BCG vaccination at the age of 0-2 mo affects TST for a long period and this condition does not change until 6 y of age.     

Isolated liver tuberculosis: a case report

A case of liver tuberculosis resembling a hemangioendothelioma on computed tomography and clinically masquerading as a tumor is reported. The cause of isolated liver tuberculosis and the importance of an open liver biopsy is discussed, with a review of the literature.     

Prevention of tuberculosis in infancy

A prospective study was conducted on 185 consecutive hospitalized cases of tuberculosis below the age of one year, and 41 mothers comprised half of the 83 contacts detected. Maternal and infant infection was analyzed to determine whether the disease could have been prevented under the existing medico-socio-economic conditions. Most mothers had delayed diagnosis and extensive disease. Earlier imperfect courses of chemotherapy were not uncommon. Ten mothers were sputum-positive for acid-fast bacilli. The concerned medical personnel failed to give proper advice with respect to chemoprophylaxis and surveillance of infants. Majority of infants had progressive pulmonary and disseminated disease although, 41% of them were BCG vaccinated. A practical strategy in the Indian context for the management of tuberculosis in the motherinfant pair is outlined.     

Congenital tuberculosis: a case with unusual features

A case of congenital tuberculosis with primary complex in the liver, localised lymphadenitis and tubercular abscess in the neck, delivered to a mother who had tubercular meningitis is discussed.     

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??Abstract??Objective??To explore the characteristics on molecular epidemiology of Mycobacterium tuberculosis isolates in chilidren and to analyse the relationship between drug resistance and genotype. Methods??Totally 150 M.tuberculosis isolated strains were collected from Children's Hospital of Chongqing Medical University and typed by MIRU genotyping.The relationship between genetic type and drug resistance was explored. Results??The 150 strains were divided into 89 distinct MIRU patterns’ and 65 isolates of them were unique. Totally 85 strains were grouped into 24 different MIRU clusters. The MIRU genotype of the largest cluster was 223325173533. Drug resistant M. tuberculosis wasn’t associated with cluster type. Conclusion??223325173533 genotype was perhaps the main epidemic strains for children in Chongqing. Drug-resistance might have no relationship with the clustering genotype.     

Peritoneal tuberculosis due to multidrug‐resistant Mycobacterium tuberculosis

The emergence of drug‐resistant Mycobacterium tuberculosis has been widely reported throughout the world, but there are very few data regarding children. We describe the case of a 14‐year‐old Peruvian adolescent who had been living in Italy since the age of 8 years and was diagnosed as having peritoneal tuberculosis (TB). While she was receiving first‐line anti‐TB therapy, she developed pyrazinamide‐associated thrombocytopenia and cultures revealed a multidrug‐resistant strain of Mycobacterium tuberculosis. Pyrazinamide, rifampicin and isoniazid were replaced by moxifloxacin, which was continued for 9 months together with ethambutol. The patient recovered without experiencing any drug‐related adverse event or the recurrence of TB in the following year. In conclusion, this case illustrates some of the problems that can arise when multidrug‐resistant TB has to be treated in children and adolescents, and also highlights the fact that further studies are needed to clarify which drugs should be used and for how long.     

Perinatal tuberculosis a case series

Perinatal tuberculosis is insufficiently understood and has been rarely reported even in areas endemic for the disease, and unless a high index of suspicion is maintained the diagnosis can be missed. Differentiation of congenital from early postnatally acquired tuberculosis is only of epidemiological importance. We hereby report one case of congenital tuberculosis and three cases of perinatal tuberculosis, and problems faced during investigation and management and emphasize need for improved screening of women at risk and sensitization of the medical community about this entity.     

血清抗结核抗体检测在结核病诊断中的价值

目的评估血清抗结核脂阿拉伯甘露糖-B(LAM-B)和相对分子质量为38-IgG抗体对儿童结核病的诊断价值。方法采用斑点免疫金渗滤法定性检测235例患儿标本[包括血清207份、脑脊液(CSF)43份、胸水8份、腹水5份、胃液4份]中抗结核LAM-B 相对分子质量为38-IgG。结果血清抗LAM-B 相对分子质量为38-IgG阳性率:非结核病组假阳性率1.96%(2/102);结核组为26.67%(28/105),其中肺内结核组32.14%(18/56),肺外结核组20.41%(10/49),两组血清抗体阳性率差异无显著性(P>0.05);菌检阳性合并组抗体阳性率64.00%(16/25)明显高于菌检阴性组抗体阳性率34.29%(12/35),两组有显著性差异(χ2=5.173P<0.05)。结论血清抗LAM-B 相对分子质量为38-IgG检测对儿童结核病有辅助诊断价值。     

Connatal tuberculosis in a very premature infant

Connatal tuberculosis is increasing in incidence and the mortality and morbidity of this disease remains high. We report a 27-week-old, 896 g female premature infant who had mild respiratory distress syndrome after birth. She developed signs of infection, progressive pneumonia and atelectasis which did not respond to mechanical ventilation and antibiotics. At 41 days of age, Mycobacterium tuberculosis was isolated from the non-bronchoscopic bronchoalveolar lavage. The isolate was sensitive to isoniazid, rifampin, streptomycin, and pyrazinamide . Miliary tuberculosis was subsequently diagnosed in her mother on a chest X-ray film and sputum cultures. The infant was treated successfully with anti-tuberculosis drugs. She had normal growth and development at the chronological age of 20 months old. Conclusion:Connatal tuberculosis should be considered in premature infants with symptoms of sepsis refractory to antibiotics. Most premature infants with connatal tuberculosis have lung involvement, and non-bronchoscopic bronchoalveolar lavage can be a useful procedure to establish the diagnosis.     

Abdominal tuberculosis in Indian children

During the period 1980–1991, 166 cases (121 surgically explored and 45 treated conservatively) of abdominal tuberculosis in children were encountered at the Children's Hospital, Institute of Medical Sciences, Banaras Hindu University. Various types of presentations and their management are discussed in the light of pertinent literature.     

Feeding intolerance due to connatal tuberculosis in a prematurely born infant

A prematurely born infant had three episodes of feeding intolerance in the first three weeks after birth. In the post-partum period, his mother, who was from the Ukraine, had a respiratory arrest; unusually, a high-resolution computerised tomograph demonstrated miliary tuberculosis (TB). As a consequence, and due to the continuing ill health of the infant, gastric aspirates were sent from the infant. Acid fast bacilli were seen on microscopy. Variable nucleotide tandem repeat analysis of acid fast bacilli facilitated the rapid diagnosis of connatal TB. We conclude that connatal TB should be considered in a prematurely born infant poorly responsive to standard management and whose mother falls into a high-risk group.     

Epidemiology of childhood tuberculosis in the Ashkelon region in Israel, 1958–1994

The incidence rates of tuberculosis (TB) in Israel decreased steadily up to 1984, but rose again between 1985 and 1991, mainly due to immigration waves from Ethiopia. The epidemiology of TB in children was surveyed in the Ashkelon region. The regional TB register of Barzilai Medical Centre, kept since 1958, was used as the source for our data. Two hundred and fifty TB cases in children were reported between 1958 and 1994, constituting 9.7% of the total 2565 cases reported in the whole population of Israel's southern Mediterranean coast. While in the late 1950s and early 1960s the majority of reported cases occurred in children of North African origin, reflecting the large wave of immigration from North Africa at that time, in 1985-94 at the time of the Ethiopian immigration wave, Ethiopian children constituted the majority of the patients. They were diagnosed up to 9 years after arrival. None of the reported cases was HIV-positive.     

Congenital tuberculosis: Late manifestation of the maternal infection

Tuberculosis in pregnancy though not uncommon, congenital tuberculosis continues to be a rare entity. A case of congenital tuberculosis where the mother manifested the disease 3 months after it was diagnosed in the newborn is reported considering its rarity.     

Prevalence of tuberculosis infection among homeless young people in central and eastern Sydney

OBJECTIVE: To determine the prevalence of tuberculosis (TB) infection among homeless young people (aged 12-25 years) in central and eastern Sydney. METHODOLOGY: A cross-sectional survey was conducted in 16 youth refuges and four drop-in centres in Central and Eastern Sydney Health Areas and at the Cellblock Youth Health Centre, Glebe and the Kirketon Road Centre, Darlinghurst, New South Wales (NSW). Participants completed a questionnaire and underwent Mantoux testing. RESULTS: One hundred and forty-one young people completed questionnaires and 139 received a Mantoux test; 112 (80. 6%) had their Mantoux read and 10 (8.9%) were Mantoux positive (95% confidence interval 3.6-14.2). None of the risk factors examined were found to be associated with increased risk for TB infection. CONCLUSIONS: In this sample of homeless young people in central and eastern Sydney, the Mantoux positivity rate appears to be higher than the general population in NSW, but they would not currently be considered a high-risk group for TB infection.     

Colonoscopy in the diagnosis of abdominal tuberculosis in children

Childhood abdominal tuberculosis has protean manifestations and remains a difficult diagnosis problem, often requiring surgery for pathological confirmation. Colonoscopy, however, can now be performed with safety in children and appears to offer a new and better alternative to surgery. An earlier experience confirmed its value in the management of ileocaecal tuberculosis as it provided histological proof and bacteriological information to guide chemotherapy, avoiding the need for anaesthesia and laparotomy. However, colonoscopy hasn't been helpful in the diagnosis of the 'exudative' type of abdominal tuberculosis.