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

Background: Congenital tuberculosis (TB) is uncommon and the diagnosis may be delayed. Methods: We report a case of a 26 –day- old premature, who stayed in the neonatal intensive care unit (NICU) for 18 days and was re- admitted to the pediatric intensive care unit (PICU) with recurrent vomiting and respiratory failure. A diagnosis of TB was done on the 19th day of admission. We describe the case, the management and the outcome of exposure in the NICU and PICU. Results: The mother of the patient had pathologic chest X- rays. Her sputum culture was positive for MTB. Tuberculin skin tests (TSTs) were performed on 97 infants and children and 156 NICU and PICU visitors. No TST conversion occurred in the exposed infants in the NICU. All neonates received isoniazid (INH) preventive therapy. 8/58(14%) from the NICU visitors had TST conversion. All of them had normal chest X rays. Only one of the exposed children in the PICU had TST conversion, with normal chest X ray and completed 9 months of INH without developing active disease. 3/22(14%) of the PICU visitors had TST conversion and 3 workers of the NICU had TST conversion. Conclusions: This case demonstrates the need for high index of suspicion for TB and the difficulty in diagnosis and management in this age group. Transmission of TB in this setting is unusual but can occur; this proves that a systematic approach to investigation of the exposed infants, family members and health care workers is essential