Tuberculosis, perinatal

P37.0

*Notifiable condition

DESCRIPTION

Tuberculosis acquired in the first 3 months of life. Perinatal tuberculosis may be acquired in one of the following ways:

  • Transplacental transmission – usually extrapulmonary or disseminated TB,
  • Via the passage of swallowed maternal blood or amniotic fluid during delivery – usually extrapulmonary TB, or
  • Inhalation of the bacilli during the neonatal period – usually pulmonary TB.

DIAGNOSTIC CRITERIA

  • Hepatosplenomegaly, a suggestive chest X-ray, TB exposure via a mother or close contact with another source case.
  • Positive smear or culture on any suitable sample e.g. gastric aspirate in the neonate or tissue histology suggestive of TB.
  • Endometrial swabs or sputum samples in the mother positive for M. tuberculosis . See Tuberculosis, Pulmonary.

GENERAL AND SUPPORTIVE MEASURES

  • Check drug sensitivity of source. If resistant, refer.
  • Check HIV status of mother and, if positive, test baby with HIV PCR.
  • Screen all household contacts for tuberculous infection or disease.
  • Monitor the nutritional status of the neonate.
  • Do not give BCG vaccine at birth.

MEDICINE TREATMENT

Treatment

Newborn infant of mother with tuberculosis with newborn having any signs suggestive of illness.

Intensive phase

  • Rifampicin, oral, 10mg/kg/dose once daily for 2 months.

PLUS

  • Isoniazid, oral, 10mg/kg/dose once daily for 2 months.

PLUS

  • Pyrazinamide, oral, 35mg/kg/dose once daily for 2 months.

Continuation Phase

  • Isoniazid, oral, 10–15mg/kg/dose once daily for 4 months.

PLUS

  • Rifampicin, oral, 10–15mg/kg/dose once daily for 4 months.

Prophylaxis

All asymptomatic neonates:

  • Isoniazid, oral, 10mg/kg/dose once daily for 6 months.
Weight band Daily isoniazid (INH)
100mg tablet
2-3.4 kg ¼ tablet
3.5-4.9 kg ½ tablet
5-7.4 kg ¾ tablet

During prophylaxis monitor the infant for active TB disease. After 6 months and HIV uninfected:

  • BCG vaccine.

In severely immunosuppressed patients the tuberculin reaction test can be negative in the presence of active tuberculosis.

REFERRAL

  • Patients not responding to adequate therapy.
  • Perinatal TB with a drug resistant source.