pediatrics
Perinatal Tuberculosis (TB)
Diagnosis of Perinatal TB
Culture of tracheal aspirate, gastric washings, urine, and cerebrospinal fluid (CSF) Chest x-ray Sometimes skin testing All neonates with suspected congenital tuberculosis and infants born to mothers who have active TB should have a chest x-ray and culture of tracheal aspirates, gastric washings, and urine for acid-fast bacilli; a lumbar puncture should be done to measure cell counts, glucose, and protein as well as to obtain CSF for culture. The placenta should be examined and cultured as well. Skin testing is not extremely sensitive, particularly initially, but should be done. TB-specific interferon-gamma release assays, which are useful in adults, are not approved for use in infants because of low sensitivity. Biopsy of the liver, lymph nodes, lungs, or pleurae may be needed to confirm the diagnosis. Diagnosis should be done. Well-appearing neonates whose mothers have a positive skin test but a negative chest x-ray and no evidence of active disease should have close follow-up, and all household members should be evaluated. If there is no exposure to a case of active TB, the neonate does not need treatment or testing. If significant exposure to a case of active TB is found in the neonate’s environment after birth, the neonate should be evaluated for suspected TB as described previously. Skin testing is not extremely sensitive for perinatal tuberculosis, particularly initially, but should be done. 