ABSTRACT

Introduction

Early diagnosis of tuberculosis (TB) in infants is important but is commonly missed because the symptoms are often non-specific.

Case presentation

A Nepalese male infant born at 26 weeks gestation and weighing 1227 g (97th centile) was admitted to the neonatal intensive care unit (NICU) immediately after birth for the management of his prematurity. After extubation on Day 8, his oxygen saturation became unstable and he required nasal continuous positive airway pressure with oxygen for 3 months. On Day 104, further detailed evaluation was required because there was no improvement in his respiratory condition. A computed tomography (CT) scan demonstrated scattered miliary nodules in both lung fields. Acid-fast staining for the mycobacteria and TB polymerase chain reaction (PCR) of the sputum obtained directly by laryngeal aspiration confirmed Mycobacterium tuberculosis. On Day 105, he was therefore transferred to a tertiary care hospital for further intensive care. Pathology findings suggested placental involvement with TB owing to chronic endometrial infection. In addition, a maternal abdominal CT scan demonstrated bilateral calcified lesions in the ovaries. He completed antituberculous chemotherapy and was discharged 3 months later. At 18 months of age there are no sequelae and his development is almost normal. None of the infants or medical personnel who were exposed in the NICU developed secondary TB.

Conclusion

In neonates with persistent respiratory distress, neonatologists should consider TB infection as a differential diagnosis.

Abbreviations

CLD: chronic lung disease; CRP: C-reactive protein; CT: computed tomography; IGRA: interferon-γ release assay; IVF-ET: in vitro fertilisation-embryo transfer; N-CPAP: nasal continuous positive airway pressure; NICU: neonatal intensive care unit; PCR: polymerase chain reaction; PROM: premature rupture of membranes; TB: tuberculosis; WBC: white blood cells.

中文翻译：

---

孕 26 周的婴儿患有先天性粟粒性肺结核并发需要 CPAP 的慢性肺病，在生命的第 104 天被诊断出：通过在其母亲的卵巢中检测到钙化证实了先天性肺结核

摘要

介绍

婴儿结核病 (TB) 的早期诊断很重要，但由于症状通常是非特异性的，因此通常被遗漏。

案例展示

一名孕 26 周出生、体重 1227 克（第 97 个百分位数）的尼泊尔男婴在出生后立即被送入新生儿重症监护室 (NICU) 以治疗早产。在第 8 天拔管后，他的氧饱和度变得不稳定，他需要用氧气持续进行鼻腔正压通气 3 个月。在第 104 天，需要进一步详细评估，因为他的呼吸状况没有改善。计算机断层扫描 (CT) 扫描显示两个肺野中有散在的粟粒结节。通过喉部抽吸直接获得的痰液的分枝杆菌和结核聚合酶链反应 (PCR) 的抗酸染色证实了结核分枝杆菌. 因此，在第 105 天，他被转移到三级医院接受进一步的重症监护。病理学结果表明由于慢性子宫内膜感染导致胎盘受累。此外，产妇腹部 CT 扫描显示卵巢双侧钙化病变。完成抗结核化疗，3个月后出院。18 个月大时没有后遗症，他的发育几乎正常。在新生儿重症监护病房中暴露的婴儿或医务人员均未发生继发性结核病。

结论

对于持续呼吸窘迫的新生儿，新生儿科医生应将结核感染作为鉴别诊断。

缩写

CLD：慢性肺病；CRP：C反应蛋白；CT：计算机断层扫描；IGRA：干扰素-γ释放试验；IVF-ET：体外受精-胚胎移植；N-CPAP：经鼻持续气道正压通气；NICU：新生儿重症监护室；PCR：聚合酶链式反应；PROM：胎膜早破；结核病：肺结核；WBC：白细胞。