Perinatal tuberculosis.

In this issue there are two case studies on perinatal tuberculosis (TB) comprising six infants. The paper by Parakh et al. describes the value of fibre-optic bronchoscopy in two infants for the diagnosis of Mycobacterium tuberculosis infection by detection of acid-fast bacilli (AFB) in the broncho-alveolar lavage (BAL) and subsequent positive culture. Only local anaesthetic was used. The authors also emphasise the difficulty in developing countries of diagnosing congenital TB using Cantwell et al.’s criteria because of limited diagnostic technology. The paper by Basu et al. demonstrates the effect of immunosuppression (corticosteroids and HIV infection) on the development of perinatal TB. The same authors recently reported Cushing syndrome in two infants associated with inappropriate use of corticosteroids by parents owing to lack of education. The paper demonstrates the value of PCR both in serum and CSF for diagnosis of TB in infants. Both reports emphasise the value of routine CSF examination in infants suspected of perinatal TB and, where indicated, endometrial biopsy in the mother. They also point out that in developing countries many infants may die from perinatal TB without the diagnosis having been made and thus the condition is underreported.