Neonatal tuberculosis.

We were interested to read the short report by Bate, Sinclair, and Robinson as it reminded us of a similar case, previously unreported, seen by us some years ago.' A baby girl was delivered by forceps at 36 weeks' gestation to a 19 year old married primigravida, who was a Spanish hotel waitress. After a normal pregnancy she was an emergency admission with what seemed initially to bc a pyogenic meningitis but was subsequently shown to be tuberculous meningitis, although culture for acid fast bacilli yielded negative results. Her uncle had almost certainly died from pulmonary tuberculosis. The baby was separated from her mother at birth in good condition but became jaundiced, with a maximum serum bilirubin concentration of 19(0 smol/l on the fourth day. She failed to thrive, developing a series of staphylococcal infections followed on the 22nd day by a fever of 38°C (rectal), pulse 140-172/min, irregular respirations averaging 48/min, fine crepitations in the right lower zone, and moderate hepatosplenomegaly. A chest x ray film (Figure) showed extensive coarse miliary mottling due to miliary tuberculosis. Scanty acid fast bacilli were identified on the Ziehl-Nielsen film from gastric washings. and subsequently Mycobacteriutn tuberculosis was grown on culture. Treatment was started with rifampicin 1() mg/kg! day, isoniazid 20 mg/day, and prednisone 2 mg/kg/day, and she began to gain weight slowly and was well on discharge aged 5 months, soon afterwards emigrating with her mother to Caracas, Venezuela, where she was thriving at 13 months. Our case shows features of the aspiration' type of congenital tuberculosis, as opposed to the 'haematogenous' transplacental type,2 with infected amniotic fluid entering the fetal lungs, probably intrapartumi and is unusual in that both mother and baby survived.