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SONAL PATEL, PHARM.D., is Product Knowledge Specialist, Roche, Nutley, NJ; at the time of writing she was Specialized Resident, Drug Information Service, Hoffmann-La Roche Laboratories, Nutley. EVELYN R. HERMES DESANTIS, PHARM.D., BCPS, is Director, Drug Information Service, Robert Wood Johnson University Hospital, New Brunswick, NJ, and Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ.

Address correspondence to Dr. Hermes DeSantis at the Ernest Mario School of Pharmacy, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ 08854 (ehermesd{at}rci.rutgers.edu).

Purpose. The diagnosis and treatment of congenital tuberculosis are discussed. Summary. Congenital tuberculosis is rare and fatal if left untreated. If a pregnant woman with tuberculosis is not treated, infection of the fetus can occur by hematogenous spread through the umbilical cord or by aspiration or ingestion of amniotic fluid. Signs and symptoms of congenital tuberculosis may be nonspecific, which may preclude early diagnosis and treatment. Criteria for the diagnosis of congenital tuberculosis require the infant to have a tuberculous lesion, as indicated by chest radiography or granulomas, and at least one of the following should be confirmed: (1) onset during the first week of life, (2) primary hepatic tuberculosis complex or caseating hepatic granulomas, (3) infection of the placenta or maternal genital tract, or (4) exclusion of postnatal transmission by a contact investigation. Since 2001, 21 cases of congenital tuberculosis have been reported in English-language medical journals, with the age of presentation ranging from day 1 to 90. Based on findings from published case reports, congenital tuberculosis should be considered in the differential diagnosis of newborns who have (1) nonresponsive, worsening pneumonia, especially in regions with high rates of tuberculosis, (2) nonspecific symptoms but have a mother diagnosed with tuberculosis, (3) high lymphocyte counts in the cerebrospinal fluid without an identified bacterial pathogen, or (4) fever and hepatosplenomegaly. Once diagnosed, it is essential to promptly begin treatment with isoniazid, rifampin, pyrazinamide, and streptomycin in order to decrease the mortality associated with the infection. Conclusion. Early diagnosis and treatment during the neonatal period are crucial in minimizing the fatality associated with congenital tuberculosis. Index terms: Aminoglycosides; Antituberculars; Diagnosis; Isoniazid; Pediatrics; Pregnancy; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis

 

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