Download Congenital tuberculosis in a 24 weeks gestation infant conceived

Congenital tuberculosis in a 24
weeks gestation infant conceived
after in vitro fertilization
VERONICA M SAMEDI, KYLE KUREK,
GREGORY RATCLIFF, AHMAD ABDULAZIZ,
KAMRAN YUSUF
DIVISION OF NEONATOLOGY,
UNIVERSITY OF CALGARY, CALGARY ,
CANADA
 37-year-old South –Asian woman with no
significant past medical history underwent an IVF.
 The infertility check-up before IVF detected no
abnormalities of the uterus or ovaries
 Her pregnancy was uneventful until 20 weeks of
GA when she had spontaneous rupture of
membranes.
 At 24 weeks of GA she presented with a
generalized seizure and went to precipitous labour.
 Male infant was delivered by spontaneous vaginal
delivery with APGAR scores on 4, 6, and 6 minutes
respectively.
 Resuscitation of infant in case room included intubation,
intermittent positive pressure ventilation with up 100%
oxygen, and surfactant administration.
 High Frequency Oscillation Ventilation was started in the
case room due to high FiO2 requirement and absent
chest movement.
 Early diagnosis of TB was done by placental pathology
Mother was admitted to ICU for seizures workup that confirmed diagnosis by
growth of Mycobacterium tuberculosis in both sputum and urine culture after 15
and 17 days of incubation.
Brain MRI showed
innumerable small ringenhancing lesions in
both cerebral and
cerebellar hemispheres
consistent with atypical
infection : TB.
Early diagnosis of TB was done by placental pathology
Fetal Surface: Subchorionic necrotizing granulomatous
inflammation
Infant had full screening for TB including repeated AFB culture of blood, CSF, endotracheal aspirates,
gastric aspirates, urine and stools, both mother and infant were started on course of isoniazid, rifampin
pyrazinamide and ethambutol

Day 0 of life: no specific abnormality
of the pleural surfaces and lungs.
Day 6 of life: Hazy reticular lung markings, reflecting
worsening of lung edema on background BPD.