Congenital tuberculosis localised to the ear.

We report two infants who had localised congenital tuberculous otitis. In both cases the infants presented with an ear discharge and both mothers had been diagnosed as having miliary tuberculosis. Infection is thought to have occurred in utero or during birth.     

Chronic otitis and hearing loss revealing a disseminated tuberculosis in a child]

Ear localization is sometimes the first symptom of tuberculosis. CASE REPORT: We report a case of a teen with a chronic otitis revealing a disseminated tuberculosis. The investigations showed ear, bones and pulmonary localisations. The outcome with treatment showed a persistent hearing loss. CONCLUSION: Middle ear tuberculosis should be suspected in patients with chronic otitis and risk factors of tuberculosis. A disseminated tuberculosis should be investigated and an early treatment is necessary to prevent hearing loss.     

Risk of pulmonary tuberculosis in children with congenital heart disease

Children with low-flow congenital heart lesions are reported to have an increased incidence of pulmonary tuberculosis. The aim of this study was to investigate if children with congenital heart disease have an increased incidence of pulmonary tuberculosis and to determine if patients with certain heart conditions are more susceptible to pulmonary tuberculosis than others. This retrospective study over a 6-year period showed that pulmonary tuberculosis was 2.5-fold more common in children with congenital heart disease than in normal children from the same community. Children with congenital pulmonary stenosis had a prevalence equal to those with acyanotic (ventricular and atrial septal defects) and cyanotic (transposition of the great arteries) high-flow heart lesions, whereas there were no cases of tuberculosis in children with low-flow cyanotic heart lesions such as tetralogy of Fallot. Cardiac surgery had to be postponed as a result of pulmonary tuberculosis in 7.2% of all patients in whom it was required. Over the 6-year period of the study, cardiac surgery had to be delayed in 60% of cases with pulmonary tuberculosis and congenital heart lesions so antituberculosis therapy could be completed. Physicians treating children with congenital heart lesions should maintain a high index of suspicion for the development of pulmonary tuberculosis, especially in those with acyanotic and cyanotic high-flow lesions and pulmonary stenosis.     

Congenital tuberculous lymphadenitis in a preterm infant in Greece

Congenital tuberculosis is a rare disease. The risk of tuberculosis in pregnancy has increased owing to recent changes in the epidemiology of the disease, which have led to an increased risk of congenital tuberculosis. We present a case report on a 6-d-old premature infant with tuberculous lymphadenitis. Smears of the lymphatic tissue contained acid-fast bacilli, and cultures were positive for Mycobacterium tuberculosis hominis. Polymerase chain reaction (PCR) assay of the suppurative material of the lymph node was positive for M. tuberculosis. Twenty days before onset of labour, the mother developed miliary tuberculosis and meningitis. Conclusion: The atypical clinical manifestations of congenital tuberculosis and the devastating consequences in the absence of early therapy signify the importance of early diagnosis and treatment during the neonatal period. PCR assay is a useful technique for prompt diagnosis in neonates with clinically suspected infection.     

Sensorineural hearing loss in sporadic congenital hypothyroidism.

Hearing acuity was assessed in 45 children with sporadic congenital hypothyroidism during adequate long-term treatment. Otoscopy was performed in each and additional tympanometry in some of them. Secretory otitis media was found in 6 and was treated medically or by inserting grommets in the eardrum. In these children, hearing acuity was assessed after the otitis had been cured. Hearing acuity was measured either by conventional monoaural pure-tone audiometry (125-8000 Hz) or by binaural free field testing depending on the child''s age (above and below 4 years respectively). Hearing was normal in 36 (80%) children. In the remaining 9, sensorineural hearing loss to some degree was detected affecting the higher frequencies in particular. Perceptive deafness required the use of a hearing aid in 4 children. No relationship could be found between hearing acuity and chronological age or bone age at diagnosis of congenital hypothyroidism or type of hypothyroidism. Sensorineural hearing loss is common in children with congenital hypothyroidism and should be searched for carefully and systematically to avoid difficulties related to speech and language development.     

先天性结核病的研究现状

目前,结核病仍然是引发死亡的主要原因之一。先天性结核病与其他类型的结核病有不同的流行病学特点,并且在诊断治疗措施方面也有其特殊性。由于目前多数文献报道仅关注于成人结核病和年龄较长儿童结核病,故有必要对先天性结核病的一些研究作一综述。     

Adenoidectomy during early life and the risk of asthma

The objective of the study was to evaluate the risk of asthma in children who had undergone an adenoidectomy, an operation frequently performed on children with glue ear or recurrent otitis media. Two surveys were carried out, a nation-wide questionnaire returned by 483 individuals (survey A) and a survey of hospital discharge records involving 1616 children who had undergone an adenoidectomy and 161 control children who had undergone probing of the nasolacrimal duct due to congenital obstruction (survey B). The questionnaire (survey A) showed that an adenoidectomy before the age of 4 years was associated with asthma (OR 3.19, 95% CI 1.25; 8.13) and with allergy to animal dust (OR 2.50, 95% CI 1.27; 4.95). In survey B, asthma diagnosis was retrieved from the national asthma register. It showed also that adenoidectomy at an early age was associated with an increased risk of asthma (OR 6.74, 95% CI 2.99; 15.2). There was an association between asthma and adenoidectomy, even before adenoidectomy had actually been performed. The risk of asthma was highest among children who had had adenoidectomy because of recurrent otitis media. The observed association between an adenoidectomy and asthma may be explained by an underlying factor predisposing to both recurrent otitis media and asthma.     

Laryngeal tuberculosis in childhood

Laryngeal tuberculosis is an extremely rare condition in childhood, although probably less so in the underdeveloped world. We have described two cases treated concurrently in our wards. The first case showed features of a pharyngopalatotonsillar membrane, an exquisitely painful edematous pharynx and larynx and was initially sputum-negative for acid-fast bacilli. This presentation fits the hematogenous form of disease and stresses that: laryngeal tuberculosis is not confined to cases of far advanced pulmonary tuberculosis; tuberculosis should enter the differential diagnosis of pharyngeal, tonsillar and palatal lesions (especially membranoulcerative lesions); and there is a common association between laryngeal and abdominal tuberculosis. Her treatment included a 1-month course of steroids and to date (12 months after onset) she shows no signs of complications. The edematous form of laryngeal tuberculosis may be yet another indication for the use of steroids in tuberculosis. Our second patient presented with prolonged chest symptoms, initial positive sputum for acid-fast bacilli and localized granulomatous laryngeal disease, features of far advanced "adult" disease and bronchogenic laryngeal spread. Laryngeal tuberculosis usually responds rapidly to antituberculosis chemotherapy. This was clinically and endoscopically confirmed in both our cases.     

Tuberculosis mimicking ileocecal intussusception in a 5-month-old girl

A 5-month-old girl was diagnosed with tuberculosis, mimicking ileocecal intussusception. The mother of the patient was later diagnosed with renal tuberculosis attributable to the same (unique) Mycobacterium tuberculosis strain. Possibly, that transmission occurred by aspiration or ingestion of infected amniotic fluid or urine, which could occur before or during birth. This case illustrates that tuberculosis can mimic other common diseases and, therefore, can be a difficult diagnosis to make. Because respiratory infection was very unlikely in this case, congenital tuberculosis or postnatal infection via infected urine or breast milk should be in the differential diagnosis. In this article, we focus on different (nonrespiratory) transmission routes of Mycobacterium tuberculosis and give a short review of the recent literature on congenital tuberculosis.     

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.     

Congenital tuberculosis. Review and diagnostic guidelines

A review of congenital tuberculosis was prompted by the successful treatment of this disease in a unique patient. She was followed up for 27 years, and gave birth to two normal, uninfected newborns despite calcifications throughout her abdomen and elsewhere. Tuberculosis of the newborn, whether acquired congenitally or postnatally, is preventable. Recommendations for diagnosis of congenital tuberculosis are given. Determination of the mother's tuberculin status or suitable testing should be done early in pregnancy. Endometritis is cited as an unrecognized source of fetal infection.     

Congenital tuberculosis associated with maternal asymptomatic endometrial tuberculosis

This is a report of a 4-month-old baby girl who presented with respiratory distress, bronchopneumonia, marasmus and hepatosplenomegaly and proved to have congenital tuberculosis on the basis of a strongly positive Mantoux test and liver biopsy findings. Endometrial biopsy in the asymptomatic mother confirmed the source of infection and the perinatal onset of illness. The age range of previously reported cases of congenital tuberculosis is 1-84 days and this case would appear to be the latest presentation of congenital tuberculosis in the literature.     

Congenital tuberculosis (author's transl)

A prematurely born infant (35 weeks of gestational age) developed signs of respiratory insufficiency, and fever, beginning at the 17th day of life; x-ray examinations showed small and large spotted lung infiltrations which grew and confluated rapidly in spite of broad antibiotic treatment. At the 29th day intubation and artificial ventilation became necessary; cultures of tracheal fluid remained sterile, Ziehl-Neelsen stains were not done. The infant died at the age of 35 days. Only at autopsy the diagnosis " congenital tuberculosis" could be made; examinations of the mother who was thought to be healthy, revealed a severe epitheloid cell tuberculosis of the endometrium. -- Mode of transmission, pathology, clinical symptoms, prophylaxis, and therapy of congenital tuberculosis are being reviewed.     

Childhood Lichen Scrofulosorum Revisited

Lichen scrofulosorum (LS), an uncommon cutaneous tuberculous reaction, has been described in children and young adults. In the last three decades, there has been a dearth of literature on the entity in children, despite a global increase in tuberculosis. It is usually associated with localized cervical, hilar, or mediastinal lymphadenopathy or with osseous tuberculosis. The occurrence of LS in association with pulmonary tuberculosis is rare and its occurrence with generalized lymphadenopathy is unrecognized. We report LS in two children and highlight its occurrence with pulmonary tuberculosis and generalized lymphadenopathy. Received March 15, 1999; accepted July 23, 1999.     

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.     

Bronchoesophageal fistula of tuberculous origin in a child

Bronchoesophageal fistulas (BEF) are uncommon in children, the etiology being congenital or acquired. Acquired bronchial perforation of tuberculous origin is common in children with pulmonary tuberculosis but bronchoesophageal perforation secondary to tuberculosis and leading to a fistulous tract formation is rare [1]. To date, there have only been 4 case reports of BEF of tuberculous origin in children [1]. We present yet another case of an acquired BEF of tuberculous origin in a child who presented with a sudden onset of dysphagia and choking sensation.     

Tuberculosis (presumed congenital) in a neonatal unit in Dar-es-Salaam, Tanzania.

This is the first report of congenital tuberculosis from Tanzania. It discusses the problems of diagnosis in a typical neonatal unit in a developing country. Three cases are reported within 1 year. Failure to thrive was the most common symptom. We speculate that congenital tuberculosis is not rare and carries a high mortality. There is need to have a high index of suspicion especially where maternal HIV and tuberculosis are highly prevalent.     

Congenital tuberculosis: the value of laboratory investigations in diagnosis

Two cases of congenital tuberculosis are described. Case 1 presented at 12 days of age. The mother had been symptomatic for tuberculosis in the 1st trimester but was not diagnosed until her infant developed symptoms. The infant's gastric aspirate was acid-fast-bacilli (AFB)-positive and Mycobacterium tuberculosis culture-positive. PCR on the gastric specimen and mother's sputum demonstrated identical strains. Case 2 presented at 45 days of age and the gastric aspirate was both AFB- and culture-positive. The mother was asymptomatic and contact-tracing of the family failed to detect infection. However, genital tuberculosis was demonstrated on an endometrial biopsy.     

Perinatal tuberculosis: four cases and use of broncho-alveolar lavage

Despite the high prevalence of tuberculosis in adults and children, congenital and perinatal forms of tuberculosis are rare. Four patients with perinatal tuberculosis are described. Diagnosis was made by demonstration of acid-fast bacilli (AFB) on broncho-alveolar lavage (BAL) specimens (two cases), gastric aspirate smear (one case) and lymph node fine-needle aspirate (one case). All of the above specimens were subsequently positive on culture. Two infants died of progressive pulmonary failure, and one of the mothers died, despite the institution of anti-tuberculous therapy. BAL specimen examination for AFB is useful in the diagnosis of perinatal tuberculosis, especially in infants with smear-negative gastric aspirate.     

Successful stenting of congenital bronchial stenosis in infancy

Recently, stent implantation has become the treatment of choice for patients with tracheobronchial stenosis due to malignant tumours, tuberculosis and recurrent stenosis following lung transplant. However, reports on this procedure in infants with congenital bronchial stenosis are extremely rare. We report successful stent implantation in an infant with congenital left bronchial stenosis followed by rapid improvement in his respiratory condition. Conclusion The use of a stent in infants is still controversial because size mismatch will take place with growth. However, we believe that implantation of a metallic stent can be the preferred treatment of congenital bronchial stenosis even in small infants. Received: 4 November 1997 / Accepted in revised form: 10 June 1998