Congenital tuberculosis: difficulties of early diagnosis.

Background. - Neonatal and/or congenital tuberculosis is insufficiently und erstood. Cae reports. - Case 1. A premature hypnotrophic neonate presented at the ag e of 45 days, without any maternal contact, a bilateral bronchopneumopathy. Whilst the pregnancy and birth had not been affected by any noteworthy pro blem, the mother died from miliary tuberculosis despite rifampin, isoniazid and pyrazinamide treatment. Her baby also died on da 52 from multivisceral failure. Culture of tracheal secretions confirmed a few weeks later the di agnosis of tuberculosis. Case 2. A premature, hypnotrophic neonate presente d on day 22 signs of respiratory distress (miliary), icterus and hepatosple nomegaly. Whilst the pregnancy and birth had not been affected by any parti cular problem, the mother, 18 days after giving birth, presented miliary an d pleural tuberculosis. Despite treatment with rifampin, isoniazid and pyra zinamid started on day 22, the baby died on day 27 from multivisceral failu re. The post-mortem liver biopsy confirmed the diagnosis of tuberculosis. C ase 3. A baby born at term was hospitalized on day 4 for jaundice. Whilst t he pregnancy and birth had not presented any problem, the mother developed a pleural tuberculosis on day 10. Breast-feeding was stopped. Due to the pr esence of opacities at the top of the right lung, the child ws given rifamp in isioniazid, and pyrazinamide. The course was marked by the appearance of hepatomegaly and poor weight gain up to day 25, followed by an improvement . Conclusion. - The frequency of congenital tuberculosis is probably under-es timated. Its early diagnosis is essential but often difficult as the initia l manifestations are delayed. Improved screening of women at risk and sensi tization of the medical community are necessary. (C) 1999 Elsevier, Paris.