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LETTER TO THE EDITOR
Year : 2014  |  Volume : 17  |  Issue : 4  |  Page : 167-168

Congenital tuberculosis a diagnostic dilemma: How practical is the Cantwell criteria in a resource-limited setting?


1 Department of Paediatrics, Bayero University, Kano, Nigeria
2 Department of Nursing, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication11-Dec-2014

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1118-8561.146824

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How to cite this article:
Aliyu I, Ibrahim Z. Congenital tuberculosis a diagnostic dilemma: How practical is the Cantwell criteria in a resource-limited setting?. Sahel Med J 2014;17:167-8

How to cite this URL:
Aliyu I, Ibrahim Z. Congenital tuberculosis a diagnostic dilemma: How practical is the Cantwell criteria in a resource-limited setting?. Sahel Med J [serial online] 2014 [cited 2022 Jul 5];17:167-8. Available from: https://www.smjonline.org/text.asp?2014/17/4/167/146824

Sir,

Tuberculosis (TB) remains a public health concern in Nigeria. Diagnosing TB in children is mainly clinically based and with high index of suspicion with little or no microbiologic laboratory support.

While disseminated, pulmonary and tuberculous meningitis are the common forms of TB reported in children, [1] there is a rarity of congenital TB with few reported cases. [2],[3],[4],[5] therefore the case of a 4-week-old infant is highlighted

A 4-week-old boy was admitted with a complaint of 3 weeks history of difficulty in breathing and fever. He was not cyanosed and had no dysmorphic feature. He received antibiotics for 2-weeks in a general hospital without improvement. His mother had chronic cough and was diagnosed with human immunodeficiency viral infection with pulmonary TB. The chest X-ray showed bilateral patchy opacities [Figure 1] and was commenced on anti-TB therapy (isoniazid, rifampicin, and pyrazinamide). However, respiratory distress worsened, and patient died on the 2 nd day of commencement.
Figure 1: Bilateral lobar pneumonia

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Congenital TB is transmitted from an infected pregnant mother via: The placental, aspiration of infected amniotic fluid, or ingestion of infected material during passage through the birth canal; therefore the primary complex may be in liver, the lungs or the gastrointestinal tract - the primary complex was located in the lungs in the index case. Criteria for diagnosing congenital TB were first established by Beitzke in 1935. [6] These were further modified by Cantwell et al. which proposed that the infant must have a proven tuberculous lesion and at least one of the following: "(i) Lesions in 1 st week of life, (ii) primary hepatic complex or caseating hepatic granuloma, (iii) TB infection of placenta or maternal genital tract, or (iv) exclusion of postnatal transmission by thorough contact investigation". [7]

In a resource-limited setting meeting these criteria will be a daunting task because (a) Establishing the diagnosis is difficult, especially in most centers that lack adequate laboratory services, (b) most patient present late to tertiary centers, therefore establishing the diagnosis in the 1 st week of life or affectation of the placenta is impossible, (c) since there are other modalities of spread, the primary focus may not necessarily be in the liver and (c) more so poor resources limit extensive contact tracing. Therefore, the criteria proposed by Patel and DeSantis, which states that "(a) congenital TB should be considered in a newborn whose pneumonia is worsening or unresponsive to routine antibiotics especially in an area with high TB burden, (b) patient with nonspecific symptoms whose mother is diagnosed with TB as in the index case, (c) patients with lymphocytic pleocytosis without identifiable bacteria or (d) fever with hepatosplenomegaly", [8] should be adopted. However, fever with hepatosplenomegaly may be due to bacterial sepsis therefore the addendum of fever with hepatosplenomegaly that is unresponsive to antibiotics in the absence of positive blood culture should be appropriate.

While mortality from congenital TB remains high (50%) [6] early diagnosis and commencement of treatment will significantly improve on survival. Unfortunately, the index case presented late and did not benefit from treatment.

 
  References Top

1.
Peterside O, Adeyemi OO, Kunle-Olowu OE, Akinbami FO, Omene J, Frances AD. Congenital tuberculosis: A case report and review of the literature. Niger J Paediatr 2012;40:93-6.  Back to cited text no. 1
    
2.
Sathiakumar N, Anene EN. Congenital tuberculosis. A case report. Niger J Paediatr 1987;14:27-9.  Back to cited text no. 2
    
3.
Orogade AA, Ogala WN, Onalo R. Congenital tuberculosis: A case report. Niger J Paediatr 2011;38:100-3.  Back to cited text no. 3
    
4.
Airede KI. Congenital miliary tuberculosis. Ann Trop Paediatr 1990;10:363-8.  Back to cited text no. 4
    
5.
Balasubramanian S, Shivram R, Padmasani LN, Nagaraju. Congenital tuberculosis. Indian J Pediatr 1999;66:148-50.  Back to cited text no. 5
    
6.
Ray M, Dixit A, Vaipei K, Singhi PD. Congenital tuberculosis. Indian Pediatr 2002;39:1167-8.  Back to cited text no. 6
    
7.
Cantwell MF, Snider DE Jr, Cauthen GM, Onorato IM. Epidemiology of tuberculosis in the United States, 1985 through 1992. JAMA 1994;272:535-9.  Back to cited text no. 7
    
8.
Patel S, DeSantis ER. Treatment of congenital tuberculosis. Am J Health Syst Pharm 2008;65:2027-31.  Back to cited text no. 8
    


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