Journal Article

Congenital Tuberculosis in a Neonatal Intensive Care Unit: Case Report, Epidemiological Investigation, and Management of Exposures

Lucia H. Lee, Charles M. LeVea and Paul S. Graman

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 3, pages 474-477
Published in print September 1998 | ISSN: 1058-4838
Published online September 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514690
Congenital Tuberculosis in a Neonatal Intensive Care Unit: Case Report, Epidemiological Investigation, and Management of Exposures

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Disseminated tuberculosis was diagnosed at the autopsy of a 65-day-old premature infant who died in a 52-bed neonatal intensive care unit (NICU). Both parents and one sibling had previously had positive tuberculin skin tests (TSTs); none had active pulmonary tuberculosis, but a second sibling had hilar adenopathy. Congenital transmission was confirmed by isolation of Mycobacterium tuberculosis from the mother's endometrium and the infant's lung tissue. Both strains were identical by DNA restriction fragment analysis. TSTs were performed on 14 neonates, 27 NICU visitors, 11 contacts of the family, and 260 health care workers. TST conversion occurred in two nurses (0.8%); both had normal chest radiographs and received isoniazid therapy. Exposed neonates had negative chest radiographs, had negative gastric aspirates for acid-fast bacilli, and received isoniazid preventive therapy. Diagnosis of congenital tuberculosis requires a high index of suspicion. Transmission of tuberculosis in the NICU setting is unusual but can occur.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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