Tuberculosis in the Neonate

Tuberculosis (TB) is the most common infectious disease in the world, with more than one million new cases and 210,000 deaths in children annually (Murray et al., Lancet 384, 1005–70, 2014). Over two billion people are infected with Mycobacterium tuberculosis, and rates of TB disease are increasing among women of child-bearing age in developing countries (Hageman, J Perinatol. 18, 389–94, 1998; Margono et al. Obstet Gynecol. 83, 911–4, 1994; Starke, Clin Perinatol. 24, 107–27, 1997). Although TB infection and disease are very common, perinatally acquired infection and disease are rare and incompletely understood (Peker et al. Tuberk Toraks. 58, 93–6, 2010). Perinatally transmitted TB can be acquired vertically during the intrauterine period (congenital TB) or shortly after birth (postnatal) through exposure to someone with contagious pulmonary disease (Starke, Clin Perinatol. 24, 107–27, 1997; Malhame et al. PLoS One 11, e0154825, 2016). Differentiating congenital and postnatally acquired TB is only important from an epidemiological standpoint as their clinical presentations, management, and prognosis are indistinguishable (Singh, J Trop Pediatr. 53, 135–8, 2007). Distinguishing TB infection from disease is important in determining management. If a person has a positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) with a normal CXR and is asymptomatic, he/she is considered to have TB infection. A person who has a positive TST or IGRA with an abnormal CXR or symptoms consistent with TB such as fever, cough, or weight loss is considered to have TB disease.