7.2.2. Congenital and neonatal TB

Congenital TB is TB disease acquired in utero through haematogenous spread via the umbilical cord or at the time of delivery through aspiration or ingestion of infected amniotic fluid or cervicovaginal secretions. Congenital TB usually presents in the first 3 weeks of life and has a high mortality rate. Neonatal TB is TB acquired after birth through exposure to a person with infectious TB (usually the mother but sometimes another close contact). It is often difficult to distinguish between congenital and neonatal TB.  Management is the same. Neonates exposed to TB may be asymptomatic or symptomatic (6).

Symptoms of neonatal TB are usually nonspecific. They include lethargy, fever, poor feeding, low birth weight and poor weight gain. Clinical signs are also nonspecific; they include respiratory distress, non-resolving pneumonia, hepatosplenomegaly, lymphadenopathy, abdominal distension with ascites, and a clinical picture of “neonatal sepsis” with disseminated TB. The diagnosis of TB should be included in the differential diagnosis of chronic neonatal infection with a poor response to antimicrobial therapy. The most important pointer to the diagnosis of neonatal TB is a maternal history of TB disease or HIV infection. Critical points in the maternal history include non-resolving pneumonia, past treatment for TB, contact with an index case of TB, and recent initiation of treatment for TB (6).

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