P3.079: Case of preterm infant with congenital tuberculosis diagnosed and successful treated in district hospital, Kigali, Rwanda.

Introduction: Congenital tuberculosis in preterm infants is uncommonly reported in limited resources countries, while in developed countries where it has been well understood and studied in the last two centuries[1]. This condition is often misdiagnosed as neonatal sepsis due to overlapping symptoms, frequently leading to delays or complete oversight in diagnosis[2].

Case Description: We are reporting a case of congenital tuberculosis in a preterm infant in Rwanda. The infant was diagnosed with pulmonary tuberculosis two months after birth while the mother was undergoing treatment for peritoneal tuberculosis as her tuberculosis test results were indeterminate. However, the infant got a GeneXpert positive Test on MTB-RH. Both the mother and the infant successfully recovered after receiving anti-tuberculosis treatment.

Discussion: We are reporting the case of a preterm male infant born at 27 weeks’ gestation, weighing 950 grams, via spontaneous vaginal delivery from a mother of 25-year-old first-time mother (G1P1), experienced premature rupture of membranes and was treated for complications related to prematurity. Following delivery, she developed persistent postpartum fevers, abdominal pain, distention, and hypogastric tenderness. An abdominal ultrasound and CT scan revealed moderate ascites.
She was then referred to Kigali University Teaching Hospital, where urine and ascitic fluid analyses were conducted. The results were indeterminate for Mycobacterium tuberculosis; however, given her clinical symptoms, she was highly suspected of having abdominal tuberculosis. Consequently, she was placed on an anti-tuberculosis treatment regimen. Following treatment, both the mother's condition and her ability to breastfeed improved, and she no longer experienced fever.
Four weeks later, her son presented with a fever, dry cough, and significant poor weight gain.
The X-rays and gastric aspirate analysis confirmed a diagnosis of pulmonary tuberculosis. Both the mother and infant underwent successful treatment with a four-drug regimen for tuberculosis and have been doing well since.

Conclusion: Pregnancy can weaken the immune system and trigger latent tuberculosis to become active. Therefore, even without definitive pathological confirmation, such as placenta pathology exams, it is crucial to maintain a high index of suspicion and conduct investigations in mothers who exhibit persistent fevers that do not respond to broad-spectrum antibiotics. Early detection and intervention may benefit the infants as well.