Machin G A, Honoré L H, Fanning E A, Molesky M
Department of Pathology, University of Alberta Hospitals, Edmonton, Canada.
Pediatr Pathol. 1992 Sep-Oct;12(5):707-16. doi: 10.3109/15513819209024224.
Perinatally acquired neonatal tuberculosis occurs rarely, is difficult to diagnose, may be the indicator of untreated tuberculosis in the mother, and could result in nosocomial transmission to neonatal patients, visitors to neonatal intensive care units, and health care workers. The disease may be more common in certain ethnic and social groups. Neonatal mortality approaches 30%. We report two cases with different outcomes. A neonate was treated for clinical miliary tuberculosis and survived; Mycobacterium tuberculosis was cultured from bronchoscopic washings, maternal genital fluids, and tissues. A second infant died at age 46 days, and autopsy disclosed miliary tuberculosis of lungs, mediastinal and mesenteric nodes, liver, spleen, and bone marrow. The lungs were most severely affected, but the placenta and central nervous system were not involved. The histopathology was not granulomatous. After the diagnosis in the infant, the mother was ascertained to have pulmonary and genital tuberculosis. Fetal and neonatal tuberculosis could be acquired transplacentally as prenatal tuberculous chorioamnionitis, perinatally through aspiration and ingestion of infected maternal genital tissues and fluid, or postnatally through droplet spread from cases of active tuberculosis. These two neonates probably acquired the disease perinatally from maternal genital tuberculosis.
围生期获得性新生儿结核病很少见，诊断困难，可能提示母亲的结核病未得到治疗，并且可能导致医院内传播给新生儿患者、新生儿重症监护病房的访客和医护人员。该病在某些种族和社会群体中可能更为常见。新生儿死亡率接近30%。我们报告了两例结局不同的病例。一名新生儿接受了临床粟粒性结核病治疗并存活；从支气管灌洗、母体生殖道液体和组织中培养出结核分枝杆菌。第二名婴儿在46天时死亡，尸检发现肺部、纵隔和肠系膜淋巴结、肝脏、脾脏和骨髓有粟粒性结核病。肺部受影响最严重，但胎盘和中枢神经系统未受累。组织病理学无肉芽肿形成。婴儿确诊后，确定其母亲患有肺结核和生殖器结核。胎儿和新生儿结核病可通过胎盘感染，如产前结核性绒毛膜羊膜炎，围生期通过吸入和摄入受感染的母体生殖道组织及液体，或出生后通过活动性结核病例的飞沫传播。这两名新生儿可能是在围生期从母体生殖器结核感染了该病。
