Original Article
Brief Report
Congenital Tuberculosis
N Engl J Med 1994; 330:1051-1054April 14, 1994
- Article
The number of cases of tuberculosis in women of childbearing age increased 41 percent in the United States between 1985 and 1992 (Centers for Disease Control and Prevention [CDC]: unpublished data). The risk of tuberculosis in pregnancy has probably also increased, leading to an increased risk of congenital tuberculosis.
We describe two patients with congenital tuberculosis. We also review the 29 cases reported since 1980 and propose revised criteria for distinguishing congenital from postnatally acquired tuberculosis.
Case Reports
Patient 1
A 24-day-old Hispanic male infant presented with a one-day history of respiratory distress, vomiting, and poor feeding. A physical examination revealed hepatosplenomegaly. A chest radiograph showed bilateral infiltrates. The white-cell count was 13,900 per cubic millimeter, with 23 percent polymorphonuclear cells, 39 percent band forms, 6 percent myelocytes, 24 percent lymphocytes, and 8 percent monocytes. Serologic testing for human immunodeficiency virus (HIV) was negative. The serum concentration of total bilirubin was normal, alanine aminotransferase was 133 U per liter, and aspartate aminotransferase was 98 U per liter. The cerebrospinal fluid was normal. Bacterial cultures of blood, cerebrospinal fluid, and urine were negative. The patient required mechanical ventilation and received intravenous antibiotic therapy and treatment for shock and disseminated intravascular coagulation. Smears of endotracheal and gastric aspirates contained acid-fast bacilli, and cultures were positive for Mycobacterium tuberculosis. Mycobacterial cultures of urine and blood were negative. The infant initially responded to isoniazid, rifampin, and pyrazinamide and was discharged after 15 days. Subsequent problems with failure to thrive and nonadherence to therapy resolved after foster-care placement.
The infant's mother, a 26-year-old HIV-negative Hispanic woman, had fever and back pain for nine days after delivery. Her chest radiograph showed blunting of the left costophrenic angle. She denied exposure to tuberculosis. After the infant was given a diagnosis of tuberculosis, her Mantoux skin test was found to be positive, and chest radiography showed a small left pleural effusion. Examination of a sputum specimen revealed acid-fast bacilli, and M. tuberculosis was cultured from sputum and urine. An endometrial biopsy revealed caseating granulomas containing acid-fast bacilli (Figure 1Figure 1
Endometrial-Biopsy Specimen from the Mother of Patient 1, Showing a Caseating Granuloma (Center Arrow) and a Langhans' Giant Cell (Lower-Left Arrow) (Hematoxylin and Eosin, x20).), and cultures grew M. tuberculosis. Examination of the placenta revealed acid-fast bacilli in a small thrombus (Figure 2Figure 2
Placenta of Patient 1, Showing Acid-Fast Bacilli (Arrows) and Inflammatory Cells in an Intervillous Thrombus (Ziehl-Neelsen, x100).). The mother responded to antituberculous therapy. The M. tuberculosis isolates from the infant and the mother were sensitive to all antituberculous medications and had the same pattern of restriction-fragment-length polymorphism.Of the six contacts in the household, two had positive Mantoux tests on initial testing and one converted to positive on repeated testing. All three had normal chest radiographs and were given isoniazid as preventive therapy.
Patient 2
A 15-day-old Native American female infant presented with a two-day history of fever, poor feeding, and respiratory distress. A physical examination revealed hepatosplenomegaly. A chest radiograph showed a right-lung infiltrate. The white-cell count was 26,000 per cubic millimeter, with 51 percent polymorphonuclear cells, 7 percent band forms, 26 percent lymphocytes, and 16 percent monocytes. The serum concentration of total bilirubin was 1.4 mg per deciliter (24 μmol per liter), and serum concentrations of alanine and aspartate aminotransferases were normal. The cerebrospinal fluid was normal. Bacterial cultures of blood, cerebrospinal fluid, and urine were negative. The patient required mechanical ventilation and received intravenous antibiotic therapy. Smears of gastric and endotracheal aspirates contained acid-fast bacilli, and cultures were positive for M. tuberculosis. Cultures of cerebrospinal fluid and urine were negative. A Mantoux test was negative. The infant responded to treatment with isoniazid, rifampin, and pyrazinamide for two months, with streptomycin added for the first two weeks, followed by four months of isoniazid and rifampin.
The maternal grandmother was a 41-year-old Native American who had tuberculous meningitis eight months before the infant's birth. M. tuberculosis was isolated from her cerebrospinal fluid, sputum, and urine. She responded to antituberculous therapy.
The infant's mother was a 20-year-old Native American who had a positive Mantoux test at the time the grandmother's contacts were investigated, eight months before delivery. A chest radiograph showed a minimal reticulonodular infiltrate. Sputum was not obtained. The mother was treated with isoniazid as preventive therapy, which was stopped after two weeks when the pregnancy was discovered. She was asymptomatic during pregnancy and thereafter. After the infant was given a diagnosis of tuberculosis, an endometrial biopsy was performed that revealed acid-fast bacilli; the specimen was culture-positive for M. tuberculosis. The mother responded to antituberculous therapy. The M. tuberculosis isolates from the infant, the grandmother, and the mother were sensitive to all antituberculous medications and had the same pattern of restriction-fragment-length polymorphism.
All the household contacts had negative Mantoux tests except two adults with tests that had previously been positive. Both had normal chest radiographs and were not given preventive therapy.
Discussion
Tuberculous bacillemia during pregnancy may result in infection of the placenta or the maternal genital tract1,2. Such infection may then be transmitted to the fetus by hematogenous spread from the placenta to the umbilical vein or by the aspiration or ingestion of amniotic fluid contaminated by placental or genital infection. Hematogenous spread leads to the formation of one or more primary complexes in the liver or lungs, whereas the aspiration or ingestion of infected amniotic fluid results in primary complex formation in the lungs or gastrointestinal tract, respectively1-4. Hematogenous spread and aspiration of infected amniotic fluid account for approximately half the cases of congenital tuberculosis each5. Since the localization of the primary complex requires an open surgical procedure or autopsy, the mode of congenital transmission often cannot be determined, as is illustrated by the two patients described here. Coinfection with HIV, an important contributing factor to the recent rise in tuberculosis, increases the likelihood of extrapulmonary tuberculosis6. Women of childbearing age who have HIV infection may therefore be at increased risk for placental or genital tuberculosis, resulting in an increased risk of congenital transmission.
Congenital tuberculosis is rare. Blackall found 3 affected patients among 100 infants of mothers with active tuberculosis,3 but in two other series no affected patients were found among 260 and 1369 such infants7,8. Overall, fewer than 300 cases have been reported,4,5,9-12 with the most recent case in the United States reported in 198213.
When the patients described here are included, 29 cases of congenital tuberculosis have been reported in the English-language literature since the 1980 review by Hageman et al.11,13-33. The median age at presentation was 24 days (range, 1 to 84). The presenting signs and symptoms were often nonspecific (Table 1Table 1
Presenting Signs and Symptoms in 29 Cases of Congenital Tuberculosis Reported since 1980.). Chest radiographs were abnormal in 23 infants, although 18 had nonspecific infiltrates. Tuberculin skin tests at the time of diagnosis in nine infants were all negative; tests performed later in two of the nine were positive. Both infants tested for HIV infection were negative. Both biopsy and noninvasive procedures were often diagnostic (Table 2Table 2
Results of Diagnostic Procedures in 29 Cases of Congenital Tuberculosis Reported since 1980.). Only 12 mothers had had active tuberculosis. Fifteen mothers were asymptomatic and were given a diagnosis of tuberculosis only after the disease was diagnosed in their infants. Mortality was 38 percent overall and 22 percent (5 of 23) among the infants who received chemotherapy.The patients described here were typical with respect to their age at presentation and the nonspecificity of their symptoms and radiographic findings. As in many cases, the mothers had subclinical tuberculosis that was detected only after the disease in the infants was diagnosed, a finding that reinforces the importance of thoroughly evaluating all mothers of infants with suspected congenital tuberculosis. The disease in Patient 2 was potentially preventable, had preventive therapy been continued during pregnancy, as is recommended when there is evidence of recent infection34.
Patients with congenital tuberculosis and those with postnatally acquired disease should be treated similarly1,2. Neonates should receive isoniazid (10 to 15 mg per kilogram of body weight per day), rifampin (10 to 20 mg per kilogram per day), pyrazinamide (15 to 30 mg per kilogram per day), and either streptomycin (20 to 30 mg per kilogram per day) or ethambutol (15 to 25 mg per kilogram per day) for the first 2 months,1,35 followed by isoniazid and rifampin for 4 to 10 months, depending on the severity of the disease1,2. Because of the potential for optic neuritis, streptomycin is generally preferred over ethambutol in infants35. In communities where rates of resistance to isoniazid are 4 percent or less, initial regimens of three drugs may be acceptable35.
The only standardized criteria for distinguishing congenital from postnatally acquired tuberculosis were established by Beitzke in 19359. These criteria require that the infant have proved tuberculous lesions and one of the following: lesions in the first few days of life, a primary hepatic complex, or the exclusion of postnatal transmission by the separation of the infant at birth from the mother and other sources of infection. Patients meeting these criteria almost certainly have true congenital tuberculosis. These criteria have become increasingly difficult to apply in current practice, however, and have been met in only three cases since 1980. In current practice, the exclusion of postnatal transmission relies on a thorough investigation of contacts, including the infant's hospital attendants, and adherence to recommendations for the treatment of infants exposed to tuberculosis, rather than separation of the infant from the mother at birth.
The demonstration of a primary hepatic complex requires an open surgical procedure or autopsy to confirm liver and regional lymph-node involvement9. Primary hepatic complexes are seldom demonstrated in current practice (and have been found in only two cases since 1980, both at autopsy), because of reduced mortality and increased use of percutaneous liver biopsy. The presence of caseating hepatic granulomas permits congenital and postnatally acquired tuberculosis to be distinguished on the basis of liver-biopsy findings alone. In one series, caseation was seen in only 1 of 79 patients with postnatally acquired tuberculosis with hepatic granulomas,11 as compared with 7 of 14 patients with congenital tuberculosis with hepatic granulomas studied by Hageman et al.11 and 6 of 9 such patients reported since 1980.
Many authors have inferred that infection of the placenta or the maternal genital tract is necessary for congenital transmission1-5,9. Female genital tuberculosis is uncommon, with an average annual incidence of 0.036 case per 100,000 women of childbearing age in the United States from 1985 through 1991 (CDC: unpublished data). Appropriate clinical testing of the maternal genital tract was performed in 14 mothers of infants with congenital tuberculosis described since 1980. All 14 mothers were found to have genital tuberculosis. The placentas of two other infants also showed evidence of tuberculous infection.
On the basis of these considerations, we propose revised diagnostic criteria for congenital tuberculosis. The infant must have proved tuberculous lesions and at least one of the following: (1) lesions in the first week of life; (2) a primary hepatic complex or caseating hepatic granulomas; (3) tuberculous infection of the placenta or the maternal genital tract; or (4) exclusion of the possibility of postnatal transmission by a thorough investigation of contacts, including the infant's hospital attendants, and by adherence to existing recommendations for treating infants exposed to tuberculosis. Different patterns of restriction-fragment-length polymorphism in the M. tuberculosis isolates from the mother and the infant would exclude congenital transmission, although identical patterns could result from either congenital or postnatal transmission.
Some cases of postnatally acquired tuberculosis with caseating hepatic granulomas or tuberculous infection of the placenta or the maternal genital tract may be misclassified by these criteria. The advantages of the revised criteria include increased diagnostic sensitivity (e.g., 23 cases reported since 1980 met the revised criteria) and applicability in current practice, eliminating the potential for misclassification that has resulted from the lack of usefulness of the 1935 criteria. A further advantage of the revised criteria is their emphasis on evaluating the mothers of infants with suspected congenital tuberculosis, potentially improving the detection of subclinical tuberculosis in these women.
We are indebted to Chris Fox, B.S.N., Pima County Health Department, Tucson, Ariz., Carol D. Harriman, M.P.H., M.S.N., New Mexico Department of Health, Santa Fe, and Michelle P. Webster, M.D., University of New Mexico School of Medicine, Albuquerque, for clinical information regarding these patients; and to the following CDC staff members: Charles L. Woodley, Ph.D., Mycobacteriology Laboratory, for the analyses of restriction-fragment-length polymorphism in the M. tuberculosis isolates; Ms. Billie L. Swisher, Scientific Resources Program, for histotechnology support; and Mr. James Gathany, Scientific Resources Program, for photomicrography.
Source Information
From the Division of Tuberculosis Elimination, National Center for Prevention Services (M.F.C., S.E.V., I.M.O.), and the Scientific Resources Program, National Center for Infectious Diseases (E.P.E.), Centers for Disease Control and Prevention, Atlanta; the Department of Pediatrics and the Steele Memorial Children's Research Center, University of Arizona, Tucson (Z.M.S.); University Medical Center, Tucson, Ariz. (A.M.C.); Arizona Department of Health Services, Phoenix (L.S.); and the Public Health Service Indian Hospital, Albuquerque, N.M. (W.F.G.).
Address reprint requests to Dr. Cantwell at the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Rd., E-10, Atlanta, GA 30333.
- References
References
1
Smith MHD, Teele DW. Tuberculosis. In: Remington JS, Klein JO, eds. Infectious diseases of the fetus and newborn infant. 3rd ed. Philadelphia: W.B. Saunders, 1990:834-47.
2
Vallejo JG ,Starke JR . Tuberculosis and pregnancy. Clin Chest Med 1992;13:693-707
Web of Science | Medline3
Blackall PB . Tuberculosis: maternal infection of the newborn. Med J Aust 1969;1:1055-10584
Hughesdon MR . Congenital tuberculosis. Arch Dis Child 1946;21:121-138
CrossRef | Web of Science | Medline5
Siegel M . Pathological findings and pathogenesis of congenital tuberculosis. Am Rev Tuberc 1934;29:297-3096
Barnes PF ,Bloch AB ,Davidson PT ,Snider DE Jr . Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1991;324:1644-1650
Full Text | Web of Science | Medline7
Ratner B ,Rostler AE ,Salgado PS . Care, feeding and fate of premature and full term infants born of tuberculous mothers. Am J Dis Child 1951;81:471-482
Web of Science8
Rich AR. Pathogenesis of tuberculosis. 2nd ed. Springfield, Ill.: Charles C Thomas, 1951:72.
9
Beitzke H . Uber die angeborene tuberkulose Infektion. Ergeb Ges Tuberk Forsch 1935;7:1-3010
Corner BD ,Brown NJ . Congenital tuberculosis: report of a case with necropsy findings in mother and child. Thorax 1955;10:99-103
CrossRef | Medline11
Hageman J ,Shulman S ,Schreiber M ,Luck S ,Yogev R . Congenital tuberculosis: critical reappraisal of clinical findings and diagnostic procedures. Pediatrics 1980;66:980-984
Web of Science | Medline12
Nemir RL ,O'Hare D . Congenital tuberculosis: review and diagnostic guidelines. Am J Dis Child 1985;139:284-287
Web of Science | Medline13
Niles RA . Puerperal tuberculosis with death of infant. Am J Obstet Gynecol 1982;144:131-132
Web of Science | Medline14
McCray MK ,Esterly NB . Cutaneous eruptions in congenital tuberculosis. Arch Dermatol 1981;117:460-464
CrossRef | Web of Science | Medline15
Mathur RP ,Ramji S ,Cherian S ,Thirupuram S . Congenital tuberculosis. Indian Pediatr 1987;24:1144-1148
Medline16
Vidwans MA ,Pimprikar SN ,Deshpande JR . Disseminated tuberculosis and cardiac rhabdomyomata. Indian Pediatr 1992;29:763-766
Medline17
Naranbhai RC ,Mathiassen W ,Malan AF . Congenital tuberculosis localised to the ear. Arch Dis Child 1989;64:738-740
CrossRef | Web of Science | Medline18
Myers JP ,Perlstein PH ,Light IJ ,Towbin RB ,Dincsoy HP ,Dincsoy MY . Tuberculosis in pregnancy with fatal congenital infection. Pediatrics 1981;67:89-94
Web of Science | Medline19
Petrini B ,Gentz J ,Winbladh B ,Skoldenberg B ,Westin B . Perinatal transmission of tuberculosis: meningitis in mother, disseminated disease in child. Scand J Infect Dis 1983;15:403-405
Web of Science | Medline20
Stallworth JR ,Brasfield DM ,Tiller RE . Congenital miliary tuberculosis proved by open lung biopsy specimen and successfully treated. Am J Dis Child 1980;134:320-321
Web of Science | Medline21
Bate TW ,Sinclair RE ,Robinson MJ . Neonatal tuberculosis. Arch Dis Child 1986;61:512-514
CrossRef | Web of Science | Medline22
Cooper AR ,Heneghan W ,Matthew JD . Tuberculosis in a mother and her infant. Pediatr Infect Dis 1985;4:181-183
CrossRef | Medline23
Airede KI . Congenital miliary tuberculosis. Ann Trop Paediatr 1990;10:363-368
Web of Science | Medline24
Schaaf HS ,Smith J ,Donald PR ,Stockland B . Tuberculosis presenting in the neonatal period. Clin Pediatr (Phila) 1989;28:474-475
CrossRef | Web of Science | Medline25
Machin GA ,Honore LH ,Fanning EA ,Molesky M . Perinatally acquired neonatal tuberculosis: report of two cases. Pediatr Pathol 1992;12:707-716
CrossRef | Medline26
Li CK ,Chan YF ,Har CMY . Congenital tuberculosis. Aust Paediatr J 1989;25:366-367
Medline27
Thora S ,Chansoria M ,Kaul KK . Congenital tuberculosis: a case with unusual features. Indian J Pediatr 1985;52:425-427
CrossRef | Medline28
Kang GH ,Chi JG . Congenital tuberculosis -- report of an autopsy case. J Korean Med Sci 1990;5:59-64
Medline29
Haumann TJ ,Huisjes AJM ,Keizer ST ,de Waal FC . Congenital tuberculosis. Ned Tijdschr Geneeskd 1988;132:1116-1116 abstract.
Medline30
Yen CM ,Hsieh KH ,Lee CY ,Lin YH ,Hsu HC . Congenital tuberculosis: a case report. Acta Paediatr Sin 1984;25:412-41731
Sathiakumar N ,Anene EN . Congenital tuberculosis: a case report. Niger J Paediatr 1987;14:27-2932
Foo AL ,Tan KK ,Chay OM . Congenital tuberculosis. Tuber Lung Dis 1993;74:59-61
CrossRef | Medline33
Asensi F ,Otero MC ,Perez-Tamarit D ,Serrano E ,Llanes S ,Santos M . Congenital tuberculosis, still a problem. Pediatr Infect Dis J 1990;9:223-224
Web of Science | Medline34
American Thoracic Society
Web of Science | Medline35
Initial therapy for tuberculosis in the era of multidrug resistance: recommendations of the Advisory Council for the Elimination of Tuberculosis
Medline
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C. Flohr, M. Khan, I. H. Leach, I. D. A. Johnston, J. S. C. English. (2009) Cutaneous tuberculosis due to Mycobacterium bovis lasting for more than 60âyears. Clinical and Experimental Dermatology 34:8, 921-923
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CrossRef32
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John Amodio, Darius Biskup, Rafael Rivera, Shetal Shah, Nancy Fefferman. (2005) Tuberculous splenic abscess in a neonate with thrombocytopenia. Pediatric Radiology 35:9, 887-890
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P. C. Drobac, H. del Castillo, A. Sweetland, G. Anca, J. K. Joseph, J. Furin, S. Shin. (2005) Treatment of Multidrug-Resistant Tuberculosis during Pregnancy: Long-Term Follow-Up of 6 Children with Intrauterine Exposure to Second-Line Agents. Clinical Infectious Diseases 40:11, 1689-1692
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CrossRef42
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CrossRef44
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CrossRef45
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CrossRef46
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CrossRef47
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CrossRef48
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CrossRef49
Z Hatzistamatiou, J Kaleyias, U Ikonomidou, E Papathoma, E Prifti, C Kostalos. (2003) Congenital tuberculous lymphadenitis in a preterm infant in Greece. Acta Paediatrica 92:3, 392-394
CrossRef50
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CrossRef51
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CrossRef52
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CrossRef53
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CrossRef54
Marian F. Lake. (2001) Tuberculosis in Pregnancy. AWHONN Lifelines 5:5, 35-40
CrossRef55
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CrossRef56
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CrossRef57
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CrossRef58
Curtis, Amy B., Ridzon, Renée, Vogel, Ruth, McDonough, Stephen, Hargreaves, James, Ferry, Julie, Valway, Sarah, Onorato, Ida M., . (1999) Extensive Transmission of Mycobacterium tuberculosis from a Child. New England Journal of Medicine 341:20, 1491-1495
Full Text59
Thillagavathie Pillay, Devadas G. Pillay, Manormoney Pillay, Miriam Adhikari, Adriaan W. Sturm. (1999) ARE SPECIFIC STRAINS OF MYCOBACTERIUM TUBERCULOSIS RESPONSIBLE FOR DISEASE IN NEWBORNS?. The Pediatric Infectious Disease Journal 18:9, 844-845
CrossRef60
T Pillay, PM Jeena. (1999) A neonate with haemorrhagic ascites. The Lancet 354:9182, 914
CrossRef61
MB Popli, N Mehta, VS Nijhavan, V Popli. (1998) Congenital tuberculosis. Australasian Radiology 42:3, 256-257
CrossRef62
Ellen Mason, Karen Rosene-Montella, Raymond Powrie. (1998) MEDICAL PROBLEMS DURING PREGNANCY. Medical Clinics of North America 82:2, 249-269
CrossRef63
MIRIAM ADHIKARI, THILLAGAVATHIE PILLAY, DEVADAS GANESH PILLAY. (1997) Tuberculosis in the newborn: an emerging disease. The Pediatric Infectious Disease Journal 16:12, 1108-1112
CrossRef64
Nesrin Şenbil, Figen Şahin, M. Kazim Çağlar, Ayşegül Oksal, Filiz Yilmaz, Fevzi Tuna. (1997) CONGENITAL TUBERCULOSIS OF THE EAR AND PAROTID GLAND. The Pediatric Infectious Disease Journal 16:11, 1090-1091
CrossRef65
Garland D. Anderson. (1997) Tuberculosis in pregnancy. Seminars in Perinatology 21:4, 328-335
CrossRef66
Laura Riley. (1997) PNEUMONIA AND TUBERCULOSIS IN PREGNANCY. Infectious Disease Clinics of North America 11:1, 119-133
CrossRef67
Armando G. Correa. (1997) UNIQUE ASPECTS OF TUBERCULOSIS IN THE PEDIATRIC POPULATION. Clinics in Chest Medicine 18:1, 89-98
CrossRef68
Ann M. Loeffler, Jay M. Milstein, David L. Kosh. (1996) FEVER, HEPATOSPLENOMEGALY AND RASH IN A NEWBORN. The Pediatric Infectious Disease Journal 15:8, 721-722
CrossRef69
ARLENE D. BARDEGUEZ. (1996) Management of HIV Infection for the Childbearing Age Woman. Clinical Obstetrics and Gynecology 39:2, 344-360
CrossRef70
Sandra M. Simpkins, Carmen P. Hench, Gulshan Bhatia. (1996) Management of the Obstetric Patient With Tuberculosis. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 25:4, 305-312
CrossRef71
K. SCOTT MILLER, JOSEPH M. MILLER. (1996) Tuberculosis in Pregnancy:Interactions, Diagnosis, and Management. Clinical Obstetrics and Gynecology 39:1, 120-142
CrossRef72
Charlah A. Robinson, Nancy C. Rose. (1996) Tuberculosis. Obstetrical & Gynecological Survey 51:2, 115-124
CrossRef73
Laura S. Inselman. (1996) Tuberculosis in children: An update. Pediatric Pulmonology 21:2, 101-120
CrossRef74
PC Ng, J Hiu, TF Fok, EAS Nelson, KL Cheung, W Wong. (1995) Isolated congenital tuberculosis otitis in a preterm infant. Acta Paediatrica 84:8, 955-956
CrossRef75
A. J. Nahmias, A. de Sousa, R. Freiji, F. K. Lee. (1995) Older and newer challenges of tuberculosis in children. Pediatric Pulmonology 19:S11, 28-29
CrossRef76
(1994) Congenital Tuberculosis. New England Journal of Medicine 331:8, 548-549
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