Congenital Tuberculosis

Congenital tuberculosis may be defined as tuberculosis occurring in infants as a result of infection with Myco. tuberculosis during intra-uterine life. The condition has been the subject of much controversy in the past; some have refused to accept it as a pathological entity, others, such as Baumgarten (1925), have ascribed many cases of tuberculosis occurring in young persons to a congenital origin. However, the present century has seen the establishment of the disease as a rare but well defined entity. It appears in two main forms: one in which the lesions are most prominent in the lungs and which is thought to be due to aspiration of infected amniotic fluid by the foetus, the other in which the earliest lesion is found in the liver and its regional lymph nodes. A third form, in which death of the foetus occurs before the development of macroscopic lesions, is known as tuberculous bacillaemia. Two essential facts must be clearly established in every example of the disease. First, it must be proved to be a result of tuberculous infection: secondly, the infection must have occurred during intra-uterine life. A number of authors have laid down conditions which each reported case must satisfy, and of these Beitzke (1935) appears to have provided the most satisfactory criteria. He proposed that a case should not be accepted as congenital tuberculosis unless (1) the presence of Myco. tuberculosis in the infant was proved, and (2) either (a) a primary tuberculous complex was present in the liver, or (b) the tuberculous lesions were present at birth, or (c) extra-uterine infection could be excluded with certainty. Using these criteria, Beitzke (1935) reviewed the literature and accepted 61 cases of congenital tuberculosis and 40 of tuberculous bacillaemia. Hughesdon (1946), using the same criteria as Beitzke, accepted a further six cases of congenital tuberculosis, one case of tuberctilous bacillaemia and added four cases of congenital tuberculosis of her own. Since then I have found 18 published cases for which a congenital origin was claimed, of which 10 satisfy the conditions required by Beitzke, Jordan and Spencer (1949), Hertzog, Chapman and Herring (1949), Ballabriga Aguado (1950), Germain, Andre and Marty (1950), Pagel and Hall (1946), Aufdermaur (1947), Daamen (1947), Danjou (1947), Wallgren (1948) and Debre, Furiet-Laforet and Royer (1948). To date 83 cases of congenital tuberculosis and 41 cases of tuberculous bacillaemia have been described. Of these, nine have occurred in the British Isles: those of Andrewes (1903), Morley (1929), Price (1937), Davin-Power (1941), Hughesdon (1946) and Jordan and Spencer (1949). A further case of congenital tuberculosis is presented here.