1196. Congenital Tuberculosis Following In Vitro Fertilization:  Case Series of Five Indian Infants from New Jersey
Session: Poster Abstract Session: Other Bacterial Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Urogenital tuberculosis (UGTB) is a major cause of infertility among women from high TB burden countries. In vitro fertilization (IVF) advances have allowed many women with primary infertility, including those with undiagnosed UGTB, to conceive. Pregnancy in women with UGTB places the fetus and newborn at risk for congenital TB, with its significant morbidity and mortality.

Methods: We describe 5 IVF infants (1 singleton and 2 sets of twins) with congenital TB, born to women from India at 3 different New Jersey hospitals in the past 5 years.

Results: The cases are summarized:

 

 

Year of birth

Gender

Estimated gestational age (weeks)

Age at presentation

(days)

Clinical manifestations

Positive specimens

Outcome

 

 

 

 

 

 

 

 

 

Baby (1)

 

2006

Male

32

24

Lethargy, mild respiratory distress; late-onset sepsis-like illness progressing to respiratory failure

Blood, gastric aspirate, tracheal aspirate; mother’s endometrial biopsy; Mycobacterium tuberculosis complex

Recovered

Twin A (2)

 

2007

Female

35

29

Fever, mild respiratory distress, pneumonia (miliary)

Gastric aspirate; mother’s endometrial biopsy (histology and smear positive) and sputum (smear negative, but culture positive); M. tuberculosis complex

Recovered

Twin B (3)

 

2007

Female

35

29

Fever, mild respiratory distress, pneumonia

Twin’s gastric aspirate; mother’s endometrial biopsy (histology and smear positive) and sputum (smear negative, but culture positive); M. tuberculosis complex

Recovered

Twin A (4)

 

2011

Male

31

19

Respiratory distress, late-onset sepsis-like illness progressing to intractable respiratory failure

Lungs and pleura at autopsy; mother’s endometrial biopsy; M. africanum

Deceased

Twin B (5)

 

2011

Female

31

33

Apnea and bradycardia with mild respiratory distress

Mother’s endometrial biopsy; twin’s autopsy specimens; M. africanum

Recovered

Conclusion: Infants conceived by IVF and born to infertile mothers from TB-endemic countries are at risk of developing congenital TB. Our experience suggests that this is a growing problem. Evaluation for IVF in this setting should include evaluation for UGTB. Congenital TB should be considered in IVF infants with respiratory and/or sepsis-like illness born to these high-risk mothers. Further study of this issue is warranted.


Subject Category: P. Pediatric and perinatal infections

Grace Lee, MD1, John Flibotte, MD1, Genevieve Buser, MD1, Sheila M. Nolan, MD1, H Zhang1, Elizabeth P. Baorto, MD2, George D. McSherry3, Kristina N. Feja, MD, MPH4 and Robert W. Tolan Jr., MD4, (1)Children's Hospital of Philadelphia, Philadelphia, PA, (2)Goryeb Children's Hospital, Morristown, NJ, (3)Pennsylvania State University College of Medicine, Hershey, PA, (4)Pediatrics, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ

Disclosures:

G. Lee, None

J. Flibotte, None

G. Buser, None

S. M. Nolan, Pfizer: Employee, Salary

H. Zhang, None

E. P. Baorto, None

G. D. McSherry, None

K. N. Feja, None

R. W. Tolan Jr., Novartis: Speaker's Bureau, Speaker honorarium
Hoffman LaRoche: Grant Investigator, Research grant

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