Congenital tuberculosis in an extremely preterm infant and prevention of nosocomial infection |
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Authors: | Kentaro Tamura Hitoshi Kawasuji Sayaka Tachi Yukako Kawasaki Mitsuhide Nagaoka Masami Makimoto Ippei Sakamaki Yoshihiro Yamamoto Junichi Kanatani Junko Isobe Satoshi Mitarai Noriko Yoneda Satoshi Yoneda Shigeru Saito Taketoshi Yoshida |
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Institution: | 1. Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0194, Japan;2. Department of Clinical Infectious Diseases, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan;3. Department of Obstetrics and Gynecology, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan;4. Department of Bacteriology, Toyama Institute of Health, 17-1 Nakataikoyama, Imizu, Toyama, 939-0363, Japan;5. Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-0022, Japan |
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Abstract: | Congenital tuberculosis is a rare disease, especially in non-endemic countries. We present a preterm infant who developed congenital tuberculosis in a neonatal intensive care unit (NICU). The male patient, weighing 1140 g was born by cesarean section at 26 weeks gestation. The baby's respiratory condition suddenly deteriorated at 18 days old, and he was diagnosed with congenital tuberculosis after Gram stain revealed “ghost bacilli” in his tracheal aspirate. The mother, who was born in an endemic country, had fever with unknown cause during labor and was diagnosed with miliary tuberculosis after the infant was diagnosed. Both were successfully treated for tuberculosis with a four-drug regimen. The genotyping profiles of Mycobacterium tuberculosis were identical in both mother and baby based on variable number of tandem repeat (VNTR) analysis. The lineage was considered to be East-African Indian. To prevent nosocomial infection in the NICU, 23 potentially exposed infants received isoniazid for 2 months. Two infants showed a transient liver enzyme elevation that seemed to be due to isoniazid. For 10 months after the incident, there were no infants and medical staff who developed tuberculosis. Although the incidence of tuberculosis has steadily decreased in Japan, the percentage of foreign-born individuals has increased yearly, especially those of reproductive age. The evaluation of active tuberculosis should be considered in pregnant women with unexplained fever, history of tuberculosis, or emigration from high-burden areas. |
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Keywords: | Corresponding author Congenital tuberculosis Neonatal intensive care unit Nosocomial infection Preterm infant EAI East-African Indian IGRA interferon-gamma release assay NICU neonatal intensive care unit PDA patent ductus arteriosus TST tuberculin skin test VNTR variable number of tandem repeat |
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