Babies can contract tuberculosis inside the womb, through childbirth —Expert

Congenital tuberculosis was previously thought to be rare but recent changes in the epidemiology of TB have resulted in an increased risk. Fewer than 300 cases have been reported worldwide. In Nigeria, many cases of congenital tuberculosis had been reported.

Unfortunately, affected infants usually present with non-specific signs and symptoms, hence a high index of suspicion is required to make a diagnosis.

A case in 2012 was a 12-week-old male child that was admitted to the Niger Delta University Teaching Hospital (NDUTH) with complaints of difficulty with breathing and poor weight gain from birth, cough of nine weeks duration, swelling of the left side of the neck of nine weeks duration, fever of 10 days duration and passage of frequent watery stools of two days duration.

His mother had a cough from the 5th month of pregnancy that was treated with unknown drugs bought over the counter. The cough resolved four weeks before delivery.  Delivery was supervised by a traditional birth attendant.

The baby had not received any immunization. He was predominantly breastfed for four weeks, and then supplementary feeds with infant formula were added.

In Zaria, a case of a five-day-old baby who was managed for pneumonia with antibiotics for two weeks without improvement and was discharged home on parental request. At seven weeks, the baby failed to thrive.  It was only then that TB was suspected and a diagnosis made on screening.

In Nigeria, these are the tip of the iceberg of babies born with Tuberculosis, the leading cause of death from infectious diseases globally, with an estimated 10.0 million new cases in 2017 and 1 million of which were in children under age 15.  In many cases, however, the seeds of tuberculosis (TB) may be sown while still inside the womb or during delivery.

“Some children are born with tuberculosis. If a pregnant woman has TB, she can pass it to her unborn baby through the placenta, “says Dr Johnson Babalola, Programme Manager, Oyo State TB and Leprosy Control Programme. He spoke at a 3-day review meeting for media professionals in Oyo State, organized by USAID Breakthrough Action Nigeria.

He added, “a newborn that breaths in or ingests infected fluid from the birth canal or inhales infected droplets that have been coughed or sneezed into the air by family members or nursery personnel, can also get infected with TB.”

Dr Babalola said although transmission of TB from mother to child is rare, most children with a TB infection don’t become ill unless it becomes a disease. Symptoms of TB disease in a newborn include fever, reduced energy, poor feeding and difficulty breathing. These typically develop during the second or third week of life.

Over time, such children may have a delay in weight gain and physical growth (failure to thrive). Its complications also include meningitis and ear infections resulting in seizures, deafness, and death.

According to him, “After a baby inhales TB bacteria, they settle and grow in the lungs. They can then move through the bloodstream to the kidneys, spine, and brain. This is especially dangerous, particularly to babies and young children.”

He said untreated TB represents a greater hazard to a pregnant woman and her unborn baby because infants born to women with untreated TB have lower birth weight than those born to women without TB aside from other complications of the infection when it turns out to become a disease and such is not detected early and treated.

He declared that a pregnant woman should start treatment as soon as TB is suspected and the drugs used in the initial treatment do not appear to have harmful effects on the unborn baby both for her health, her baby and her close contacts.

“Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year,” he added.

Nevertheless, Dr Babalola declared that the commonest route by which an individual contacts TB is through breathing in air that has TB germs. The air gets infected when a person with TB disease of the lung coughs, laughs, talks or sneezes.

Sneezing, unlike coughing, laughing or speaking transmits more of the germ. A person with active TB disease can release between zero and 200 TB germs during a speech; up to 3,500 TB germs from a cough and between 4,500 and 1 million TB germs from a sneeze.

Howbeit, Dr Babalola said the likelihood of transmission of TB is dependent on the infectiousness of the person with TB, the environment in which exposure occurred, the duration of exposure, and the immune status of the exposed person.

Individuals also at high risk for TB disease, he listed as people with HIV infection, babies and young children, elderly people, people who inject drugs, and people who are sick with other diseases that weaken the immune system.

Others include people who were infected with TB in the last two years, people who were not treated correctly for TB in the past and contact with TB patients like households, health staff and staff of prisons.

Dr Babalola stated that a high index of suspicion is required for the diagnosis of tuberculosis in pregnancy just as screening for tuberculosis should be part of the routine prenatal care at the slightest suspicion of tuberculosis.

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