An Investigation of Confirmed Congenital Tuberculosis in Thungmaphrao Sub-District, Thaimuang District, Phang Nga Province, 4th January – 15th February 2014

Abstract

A case investigation of congenital tuberculosis as descriptive epidemiology was aimed at finding any newly infected cases and contact persons, determining behavioral and environmental risk factors, and controlling and preventing a transmission. On 2nd January 2014, an epidemiology section of Phang nga Hospital was notified by the intensive care unit that the 28-day-old smear-positive female pulmonary tuberculosis (TB) case was admitted and treated by intubation. The epidemiology section of Phang nga Hospital in collaboration with the two special rapid response teams (SRRTs) from Inthanin Sub-district Health Promoting Hospital and Phang-nga Provincial Public Health Office conducted a case investigation by using the mixed methods: interviewing medical doctors, nurses, parents, and contact persons in same house, reviewing hospital records and clinical laboratory data, finding other cases by using AFB-confirmed sputum samples and X-ray confirmed chest abnormality done by the Phang nga Hospital, and performing blood examination of the patient’s mother using Quantiferron TB-Gold based ELISA at National Institute of Health of Thailand, Department of Medical Sciences. Findings demonstrated that the hospitalized patient with pulmonary TB was shown for the positivity with AFB (or AFB1+ for 3 consecutive days), the chest abnormality based on reticulonodular infiltration on the right lobe more than the left lobe, and the liver abnormality based on elevated liver enzyme levels. Meanwhile, TB cultures using blood, urine, cerebral fluid, gastric lavage samples were consistently negative. This pulmonary TB patient confirmed as congenital TB was given antibiotics and category 1 anti-TB drugs. Of the 4 people living with TB, the patient’s mother was found to develop latent tuberculosis infection symptoms based on chest X-ray examination that revealed right lower lobe infiltration and bilateral pleural effusions, blood examination that revealed the positivity with the Quantiferron TB-Gold based ELISA. This patient was given category 1 treatment the same as pulmonary TB. The patient’s house and surroundings were hygienic. No TB suspicion was found following the observation period for other contact persons.
Behavioral risk for the congenital TB was likely to relate susceptible female infant to the infection from her mother with the latent tuberculosis infection during pregnancy, and became genetically transmitted through blood circulation. Completely operated surveillance and control measures included the isolation of the infected mother and continuation of TB treatment, mental and social support, and indoor environmental management. Recommendation for a smear-positive pulmonary TB treatment in new case is the screening of the contact persons and pregnant women to get subsequent diagnosis and prompt treatment. The directly observed treatments (DOTS) should be emphasized for an increase in radical treatment rates in all affected patients as well as a transmission interruption in the community.