Congenital tuberculosis after in vitro fertilization: suggestion for tuberculosis tests in infertile women in developing countries

Abstract

Congenital tuberculosis (CTB) after in vitro fertilization (IVF) is a major new problem in developing countries. Only 16 cases of CTB after IVF have been reported, and no tuberculosis (TB) tests were performed before IVF in these cases. However, on the basis of data in the literature and from the World Health Organization, the incidence of CTB has been substantially underestimated. We describe two cases of CTB after IVF in detail in our center and provide new insight into the important issue of controlling TB vertical transmission in developing countries. Performing an early diagnosis of CTB, mostly based on evidence of maternal infection and a high index of clinical suspicion, is a challenge. However, most mothers have no symptoms of TB infection during prepartum, and infertility may be the only symptom. Infertility caused by genital TB is common in countries with a high TB burden, and IVF is considered to be an effective treatment to improve their fertility. Therefore, this may lead to more CTB cases without thorough TB tests before IVF. We suggest that thorough TB tests should be conducted in infertile women before IVF to prevent CTB.

Keywords: Congenital tuberculosis; anti-tuberculosis therapy; in vitro fertilization; infertility; twins; vertical transmission.

Figure 1.

Hysterosalpingography, chest computed tomography, and cerebral magnetic resonance imaging of the mother and chest radiography of the neonate (case 1) (a) Hysterosalpingography suggests a normal uterus and salpingitis. (b) Maternal chest computed tomography shows miliary nodules in both lungs. (c) Maternal cerebral magnetic resonance imaging shows infiltration of brain parenchyma and meninges. (d) Chest radiography of the neonate shows diffuse infiltration of both lungs.

Figure 2.

Hysterosalpingography of the mother and chest radiography of the neonate (case 2). (a) Hysterosalpingography shows tubal obstruction of both sides, but the uterus is normal. (b) Chest radiography shows extensive patchy cloudy opacity and areas of consolidation mainly in the right lung.