A REAL CHALLENGE TO DETECT AND TREAT PERINATAL TUBERCULOSIS - A CASE REPORT

Abstract

Tuberculosis in young infants poses several          diagnostic and management challenges especially when there is no known adult contact of tuberculosis. It is not         necessary to distinguish between congenital and postnatally acquired tuberculosis since the modes of presentation,          management and prognosis are similar. Here, we report a case of perinatal tuberculosis in a 3 month old female child who presented with persistent pneumonia and                          hepatosplenomegaly since one month of age. As child did not improve with appropriate antibiotics , tuberculosis work - up was done. Gastric aspirate for AFB was negative and gastric aspirate for Cartridge Based Nucleic Acid Amplification            Test - CBNAAT(gene X-pert MTB-RIF) was positive and    bronchoalveolar lavage (BAL) sample for CBNAAT (gene             X-pert MTB-RIF) was positive. Anti- tuberculosis therapy was started on a daily basis. Since child had persistent hypoxia, oral steroids was started along with anti-tuberculosis therapy. Child required prolonged duration of anti-tuberculosis drug due to sub optimal response and a course of oral steroids for persistent hypoxia. Therefore, it is suggested that perinatal tuberculosis should be considered in the differential diagnosis of young infants with non-responsive, worsening pneumonia inspite of appropriate antibiotics. Moreover, extended            treatment for 9 to 12 months is needed for perinatal                   tuberculosis. Oral steroids may be needed till the infant           becomes oxygen independent.