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Congenital tuberculosis (CTB) is relatively rare and most patients are described in case reports. To investigate the clinical characteristics of CTB in 26 children. A retrospective analysis of 26 children with CTB from January 2013 to December 2021 in Changsha Central Hospital in Central Southern China was undertaken. The median age at onset was 25 days (17–33) and within 4 weeks of age in approximately 73% of cases. Of 24 mothers (including two mothers of twins), 18 (75.0%) were asymptomatic during pregnancy, and four were diagnosed with tuberculosis prenatally. The numbers of tuberculous meningitis, tuberculous encephalitis and liver TB were 17 (65.4%), five (19.2%) and four (15.4%), respectively. The main symptoms were fever ( n  = 18, 69.2%) and cough ( n  = 16, 61.5%). Positive rates of T-SPOT.TB, acid-fast bacilli smear, culture of  Mycobacterium tuberculosis  and GeneXpert MTB/RIF test were, respectively, 84.2% (16/19), 42.3% (11/26), 43.5% (10/23) and 83.3% (5/6). Radiograph or computed tomography demonstrated typical pulmonary tuberculous lesions in all cases and the head magnetic resonance imaging (MRI) showed marked meningeal enhancement or parenchymal lesions in seven cases (26.9%). One case had drug-resistant TB. During follow-up, nine cases had varying degrees of liver injury, and one had delayed growth and development. Eight died and 18 recovered satisfactorily. Maternal TB status during pregnancy, the epidemiological history, T-SPOT.TB and other TB-related aetiological tests and imaging are important for the early diagnosis and treatment of CTB, and are associated with a favourable outcome. AFB: acid-fast bacilli; Amk: amikacin; Cs: cycloserine; CT: computed tomography; E: ethambutol; GeneXpert MTB/RIF: GeneXpert  Mycobacterium tuberculosis  and rifampicin resistance; H: isoniazid; IVF-ET: in-vitro fertilization-embryo transfer; Lzd: linezolid; Mfx: moxifloxacin; MTB:  Mycobacterium tuberculosis ; mNGS: next generation sequencing; MTB-DNA:  Mycobacterium tuberculosis -deoxyribonucleic acid; Pto: protionamide; R: rifampicin; TB: tuberculosis; T-SPOT.TB: spot test of mycobacterium TB infection T-lymphocytes; Z: pyrazinamide.

Clinical characteristics in 26 children with congenital tuberculosis in Central Southern China: a retrospective study