Congenital pulmonary tuberculosis: a clinical observation

• Igor S. Dolgopolov
• Maksim Yu. Rykov

Abstract

Tuberculosis remains a serious challenge to the healthcare system around the world. Nevertheless, congenital tuberculosis is an extremely rare pathology. For the correct diagnosis of the illness, pediatricians need to assess not only non-specific symptoms, social, family, and maternal anamnesis, and conduct a complex diagnostic search. Delaying diagnosis carries significant risks to the life of a newborn and is accompanied by more than 50% mortality.

The article presents a microbiologically confirmed case of congenital pulmonary tuberculosis in a premature baby with a burdened family history. The clinical and X-ray picture of lung damage debuted on the 27^th day of life. The clinic was dominated by the symptoms of lung damage: shortness of breath and decreased saturation that required additional oxygen therapy, and fever. The radiological presentation allowed bilateral polysegmental infiltrative damage of the lung. M. tuberculosis was discovered from the stomach aspirate by light microscopy, followed by confirmation by DNA diagnostic and bacteriological methods. Artificial ventilation was performed from 47 to 203 days of life due to the increase in pulmonary insufficiency and respiratory symptoms. Specific anti-tuberculosis therapy has been received by the child. We have used rifampicin, pyrazinamide, moxifloxacin, and linezolid for 9 months in combination with amikacin (120 doses). Rifampicin and pyrazinamide were continued for 18 months. The child had not had physical or mental retardation at 2 years of age. There are no radiological findings.

An infectious syndrome in a premature newborn associated with pneumonia resistant to standard antibiotic therapy. The presence of tuberculosis in the mother, relatives, or siblings requires tests to detect M. tuberculosis with instrumental diagnosis. Early diagnosis and treatment based on the results of drug sensitivity determination are necessary to improve the prognosis of the disease.

Keywords:congenital tuberculosis; fever; pneumonia; premature newborn; therapy

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