India remains endemic for both vivax malaria and tuberculosis. In spite of the high burden of tuberculosis in the country, reports on congenital tuberculosis in the literature are limited. We report herein an unusual instance of co-occurrence of perinatal falciparum malaria and tuberculosis in a 34-day-old female newborn, who presented with symptoms of sepsis. The diagnosis was based on the demonstration of Plasmodium falciparum on peripheral blood smear and tubercle bacilli in gastric aspirate samples. The maternal history for falciparum malaria was positive during her eighth month of pregnancy and the father was an open case of sputum smear-positive pulmonary tuberculosis. She responded dramatically to combined antimalarial and antitubercular chemotherapy.

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A search for combined etiologies in presumed ‘sepsis’ in the newborn, guided by history, physical examination, and laboratory investigations, is warranted. Both congenital tuberculosis and congenital malaria are rarely diagnosed, even in countries endemic for the adult forms of the diseases. The presentation is usually with non-specific signs and symptoms.

A meticulous past medical history, including that of the maternal gestation and family members is often the initial suspicion-arousing event. Both the diseases are associated with extremely high mortality in the absence of timely recognition and prompt therapy. We report an unusual case of a 34-day-old female newborn with co-occurrence of perinatal falciparum malaria and tuberculosis, suspected primarily on the basis of positive maternal and family history. She responded dramatically to combined antimalarial and antitubercular therapy.

Business Law Clarkson 12th Edition Powerpoint Backgrounds Learn Ruby The Hard Way Rapidshare Downloader there. on this page. A 34-day-old, term, female infant, born to non-consanguineous parents was initially seen for a three-day history of cough and progressive lethargy, with poor breastfeeding and fever. The mother also noted that the baby had turned progressively paler over the last week. There was no history of abdominal distension, oliguria, alteration of consciousness, convulsions, or prolonged jaundice in the neonatal period. She was delivered at home by a traditional birth attendant, by spontaneous vaginal delivery, and there had been no immediate postnatal complications. She was not immunized at birth. The mother's past medical history was significant for an episode of fever due to falciparum malaria at eight months of gestation, which had been treated with chloroquine, but unfortunately not as per the recommendations of the National Malaria Eradication Programme, Department of Health and Family Welfare, Government of India. Besides this, she denied any other illnesses during her gestation or in the immediate past.

The father was an open case of sputum smear-positive pulmonary tuberculosis (PTB) with a suggestive chest radiograph, diagnosed a month previously and was on intensive phase antitubercular chemotherapy (isoniazid, rifampin, pyrazinamide, and ethambutol) with partial response. At the time of the baby's admission, the father's sputum remained positive for acid-fast bacilli (AFB; graded as 1+ (10–99 AFB per 100 fields examined) as per the guidelines of the International Union Against Tuberculosis and Lung Disease (IUATLD) x 1 Enarson DA, Reider HL, Arnadottir T, Trebucq A. Management of tuberculosis: a guide for low income countries. IUATLD; 2000. Available at: June 2009). On examination, the infant appeared pale, dehydrated, and tachypneic with labored breathing.

She weighed 2.5 kg and measured 53 cm in length (both below the third percentile for age and sex). The rectal temperature was 39 °C, and she had a heart rate of 194 per minute, a respiratory rate of 86 per minute, and an oxygen saturation of 87% in room air. Moderate intercostal, suprasternal, and subcostal chest retractions were noted. The chest auscultation revealed bilateral, diffuse crepitations with occasional rales.

The liver and the spleen were palpable 3.5 cm and 3 cm below the right and the left costal margins, respectively. Examination of the other major systems was non-contributory.

A complete hemogram showed the following: hemoglobin 6.2 g/dl, hematocrit 24%, total leukocyte count 19. Stickmuster Download Free. 7 × 10 9/l (neutrophils 67%, including band forms with toxic granulations, lymphocytes 32%), platelets 233 × 10 9/l. The erythrocyte sedimentation rate was 84 mm (first hour) and C-reactive protein was 142 mg/l (normal.