Tuberculosis can be acquired during the neonatal period. Symptoms are non-specific. The diagnosis is made by culture and sometimes X-ray or biopsy. Treatment is with isoniazid and other anti-tuberculosis drug.

Tuberculosis can be acquired during the neonatal period. Symptoms are non-specific. The diagnosis is made by culture and sometimes X-ray or biopsy. Treatment is with isoniazid and other anti-tuberculosis drug.

(Tuberculosis (TB).) Tuberculosis can be acquired during the neonatal period. Symptoms are non-specific. The diagnosis is made by culture and sometimes X-ray or biopsy. Treatment is with isoniazid and other anti-tuberculosis drug. Infants may acquire tuberculosis in the following way: Transplacental spread through the umbilical cord to the fetal liver aspiration or ingestion of infected amniotic fluid droplet infection of close contacts (family members or ward staff) About 50% of children of a mother with active pulmonary tuberculosis diagnosed during the first year of life, provided they were not treated prophylactically or no BCG vaccination has been implemented. Symptoms and signs The clinical presentation of neonatal tuberculosis is non-specific and usually characterized by involvement of multiple organ systems. The newborn can be acute or chronic look sick and may include fever, lethargy, difficulty breathing or not treatable pneumonia, hepatosplenomegaly or failure to thrive occur. Diagnosis culture of tracheal aspirate, gastric secretions, urine and CSF chest x-ray Sometimes skin tests for all newborns with suspected congenital tuberculosis and in infants of mothers with active tuberculosis, a chest x-ray and a culture of Trachealaspirats, gastric secretions and urine for acid-fast bacilli should be. A lumbar puncture should be made to measure cell number, glucose and protein and to create a culture of cerebrospinal fluid. The placenta should be examined and it should be created by their culture. Skin tests are not very sensitive, especially initially, but they should be performed. A biopsy of the liver, lymph nodes, lung or pleura may be necessary to confirm the diagnosis. The infant should be tested for HIV. Healthy-looking Infants whose mothers have a positive skin test but no signs of active disease and a negative chest X-ray should be soon re-examined. All family members should be examined. If no exposure exists to a case of active tuberkulos, the newborn needs no treatment or laboratory tests. When a significant exposure to a case with active tuberculosis in the vicinity of the newborn is detected after birth, the newborn should be examined with suspected tuberculosis as described above. Tips and risks skin test are not very sensitive to perinatal tuberculosis, especially in the beginning, but they should be performed. Treatment isoniazid (INH) with a positive skin test or a high risk of exposure, the addition of other drugs (eg. As rifampicin, ethambutol, ethionamide, pyrazinamide, an aminoglycoside) is indicated when tuberculosis is present, the treatment depends on whether it is a active tuberculosis disease or has a positive skin test (of mother, baby or both), indicating an infection without disease. Pregnant with a positive tuberculin women are tested for active tuberculosis. If active disease is excluded, treatment with isoniazid can be moved to after birth because the hepatotoxicity of isoniazid increases during pregnancy. In addition, the risk is transferred from a mother with a positive tuberculin test to get tuberculosis for newborns is higher than for the fetus. However, when the woman recently had a contact with a tuberculous person (in this case, the benefit outweighs the risks so on) can be carried out a treatment for 9 months, accompanied by supplemental pyridoxine. Treatment of the pregnant woman who has been exposed to an infectious tuberculosis should be postponed until completed the first trimester ist.Neugeborene speak with a positive tuberculin If no clinical or radiological signs of disease, should the newborn isoniazid 10-15 mg / kg po once daily receive over 9 months and be closely monitored. Exclusively breastfed newborn should pyridoxine werden.Schwangere administered 12 mg / kg once daily with active tuberculosis isoniazid, ethambutol and rifampicin, used at recommended doses, have shown no teratogenic effect on the fetus during pregnancy. The recommended in the United States initial regimen comprises isoniazid (300 mg p.o.), ethambutol (15-25 mg / kg, at most 2.5 g) and rifampicin (600 mg p.o.). All pregnant and breastfeeding women who are treated with isoniazid should also take pyridoxine (25-30 mg po). All these drugs can be taken once daily. The treatment normally lasts 9 months. In case of resistance, a specialist should be consulted. Perhaps the extent of therapy to 18 months may be necessary. Streptomycin is potentially ototoxic to the fetus and should not be prescribed unless rifampicin is not contraindicated during early pregnancy. If possible, other anti-tuberculosis (z. B. ethionamide) or should be avoided during pregnancy due to lack of experience with this drug due to its teratogenicity. Breastfeeding is not contraindicated for mothers under tuberculostatic therapy, provided they are not infectious. Patients with active tuberculosis are reported. Mothers with active tuberculosis should be tested for HIV werden.Asymptomatische Infants whose mother or close contacts have active tuberculosis The newborn is tested for congenital tuberculosis as described above and is usually only while separated from the mother until treatment of mother and child shows effectiveness , When a congenital tuberculosis is excluded and as soon as the newborn isoniazid receives a separation is no longer required, unless the mother (or family member) has resistant pathogens in itself or does not adhere (to the prescribed treatment for. Example by with active tuberculosis no mouthguard carries) and a controlled treatment is not possible. It is advisable to examine people with close contact with the family to discover a previously diagnosed tuberculosis, before the child is released. If adherence to treatment is reasonably assured and the family is not tuberculous (z. B. if the mother is treated and no other infection options are available), the newborn treatment with Isoniazin 10-15 mg / kg po can 1 time daily receive and be dismissed at the usual time. Exclusively breastfed infants should receive 1-2 kg once mg / day pyridoxine. Skin tests should be made at the age of 3 or 4 months. If the newborn is tuberculin negative and the initial infectious contact is consistently and successfully treated, the isoniazid treatment can be adjusted. If the skin test is positive, chest X-rays and cultures are performed for acid-fast bacilli, as described above. If an acute illness is excluded, the treatment can be continued with isoniazid for 9 months. If cultures respond positively to tuberculosis, the newborn for acute tuberculosis is treated. If good compliance in a nontuberculous environment can not be ensured, a BCG vaccination should be considered and INH therapy should be started as early as possible. (Although isoniazid inhibits the proliferation of Calmette-Guerin bacillus vaccines [BCG] germs can, the combination of a BCG vaccination and isoniazid treatment is based on clinical studies and advice.) The BCG vaccine does not protect against infection or development of tuberculosis, but it provides some protection against severe and disseminated infections (tuberculous meningitis). BCG should be given only when the skin and HIV test results of the newborn are negative. These children should be particularly examined in the first year of life closely for the development of tuberculous disease. (Warning: The BCG vaccination is contraindicated in immunosuppressed patients and those with suspected HIV infection However, the WHO recommends [unlike the American Academy of Pediatrics] in asymptomatic HIV-infected children BCG vaccination at or soon after. birth.) newborns with active tuberculosis the American Academy of Pediatrics recommends treatment with isoniazid (10-15 mg / kg po), rifampicin 10-20 mg / kg po, pyrazinamide (20-40 mg / kg po) and aminoglycoside ( z. B. amikacin). This treatment plan should be modified according to the test results for resistance. Pyridoxine is given when the baby is exclusively breastfed. Ethambutol is generally avoided as it causes ocular toxicity, which can not be assessed in newborns. For tuberculosis, which was acquired after birth, there is a recommended treatment in a dose of isoniazid 10-15 mg / kg p.o. Rifampicin with 10-20 mg / g p.o. and pyrazinamide 30-40 mg / kg once daily. A fourth drug such as ethambutol p.o. 20-25 mg / kg 1 times a day, ethionamide 7.5-10 mg / kg p.o. 2 times a day (or from 5 to 6.67 mg / kg po 3 times daily) or an aminoglycoside should be added when a drug resistance or tuberculous meningitis is suspected or the child is living in an area where the HIV prevalence among TB patients is ? 5%. After the first 2 months of treatment isoniazid and rifampicin continue to bring a 6-12 month treatment (depending on the clinical category) to an end. Other medications may be discontinued. Breastfed babies should receive additionally pyridoxine. In a CNS involvement, the initial therapy should include corticosteroids (prednisone 2 mg / kg p.o.1 times daily [maximum 60 mg / day] over 4-6 weeks, then tapered off). Other therapies are continued until the symptoms of meningitis disappeared and two consecutive, taken at intervals of one week Liquorkulturen are negative. After that, the therapy with isoniazid and rifampicin can even be continued for a further 10 months daily or twice weekly. Corticosteroids can also for infants and children with severe miliary disease, pleural or pericardial effusion and endobronchial disease or infants should be considered with abdominal tuberculosis. shows a tuberculosis in children, which was not acquired congenitally, no CNS, bone or joint involvement and results from drug-sensitive pathogens, can be successfully treated with a 6-9-month treatment. The been cultured from the mother or the child should be tested for bacterial agents thereof sensitivity to various drugs. Hematologic, hepatic and otology symptoms are regularly monitored to determine response to treatment and drug toxicity. Common laboratory tests are usually not necessary. The the Directly Observed Therapy Strategy is applied whenever possible in order to improve compliance and to secure the success of therapy. Most anti-tuberculosis drug is not available in doses for children. If possible, experienced personnel should administer these drugs to children. Prevention Routine BCG vaccination is not indicated in newborns in developed countries, but could reduce the incidence of disease in children and reduce the severity of the disease in susceptible risk groups. Summary tuberculosis can be acquired transplacentally, by aspiration of infected amniotic fluid or by respiratory transmission after birth. Symptoms of neonatal tuberculosis are nonspecific but usually several organs (including the lungs, liver and / or CNS) are involved. Chest x-ray and tuberculosis culture, tracheal, gastric secretions, urine and CSF are used for diagnosis. Isoniazid is recommended with a positive skin test or high risk. In addition, other drugs (eg. As rifampicin, ethambutol, pyrazinamide, ethionamide, an aminoglycoside) should be used with active tuberculosis.

Health Life Media Team

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