title: [Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (i): Epidemiology and diagnosis. Congenital tuberculosis].
abstract: Tuberculosis (TB) screening in pregnancy using tuberculin skin test (TST) is recommended in case of symptoms of TB disease, close contact with a patient with infectious TB, or high risk of developing active disease. The new interferon gamma release assay (IGRA) tests are recommended in BCG-vaccinated pregnant women with positive TST and no known risk factors for TB, and in those immunocompromised, with clinical suspicion of TB but negative TST. TB diagnosis is difficult due to the non-specific symptoms, the increased frequency of extrapulmonary disease, the delay in radiological examinations, and the high rate of tuberculin anergy. Neonatal TB can be acquired in utero (congenital TB), or through airborne transmission after delivery (postnatal TB). Congenital TB is extremely rare and does not cause fetal malformations. It may be evident at birth, although it usually presents after the second week of life. In newborns with no family history of TB, the disease should be considered in cases of miliary pneumonia, hepatosplenomegaly with focal lesions, or lymphocytic meningitis with hypoglycorrhachia, especially in those born to immigrants from high TB-burden countries. TST is usually negative, and IGRAs have lower sensitivity than in older children. However, the yield of acid-fast smear and culture is higher, mostly in congenital TB. Molecular diagnosis techniques enable early diagnosis and detection of drug resistance mutations. There is a substantial risk of disseminated disease and death.
authors.affiliation: Grupo de Infección Congénita y Perinatal de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España. Electronic address: fbaquero@terra.com.
authors.forename: F
authors.initials: F
authors.lastname: Baquero-Artigao
authors.affiliation: Grupo de Tuberculosis de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mellado Peña
authors.affiliation: Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España.
authors.forename: T
authors.initials: T
authors.lastname: Del Rosal Rabes
authors.affiliation: Unidad de Infecciones, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Noguera Julián
authors.affiliation: Servicio de Medicina Maternofetal, Institut Clínic de Ginecología, Obstetricia i Neonatologia, Hospital Clínic, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Goncé Mellgren
authors.affiliation: Unidad de Tocología de Alto Riesgo, Servicio de Obstetricia y Ginecología, Hospital La Paz, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: de la Calle Fernández-Miranda
authors.affiliation: Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Gregorio Marañón, Madrid, España.
authors.forename: M L
authors.initials: ML
authors.lastname: Navarro Gómez
mesh_terms: D000465:Algorithms; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D014376:Tuberculosis / Q000151:congenital* / Q000175:diagnosis* / Q000453:epidemiology
keywords: Congenital; Congénito; Diagnosis; Diagnóstico; Embarazo; Epidemiology; Epidemiología; Infant, newborn; Interferon-gamma release tests; Pregnancy; Prueba de la tuberculina; Recién nacido; Test de liberación de interferón-gamma; Tuberculin test; Tuberculosis