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Mukerji R, Turan JM. Challenges in accessing and utilising health services for women accessing DOTS TB services in Kolkata, India. Glob Public Health 2020; 15:1718-1729. [PMID: 32290773 DOI: 10.1080/17441692.2020.1751235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Challenges in accessing and utilising TB treatment are a major reason for the existing gaps in tuberculosis (TB) control in India. Twenty qualitative interviews were conducted with women who were attending or had attended a directly observed treatment short course (DOTS) clinic in Kolkata, India. The resulting data were analysed using a thematic approach. Our results indicated that women experienced several challenges categorised as (1) DOTS specific challenges, (2) lack of client friendly services, and (3) resource constraints. DOTS specific challenges included having to come to the clinic for medicines, lack of privacy, providers minimising contact with patients, length of treatment, drug side effects and pill burden. Lack of client friendly services led to mistrust in government services and a preference for private providers, which was compounded by corruption in the medical system. Inability to complete household duties due to inflexible clinic hours, long lines and overcrowded spaces, and mistreatment from providers were further challenges faced by women. Lastly, resource constraints meant women faced financial difficulties with additional treatment costs and suffered from lack of adequate food and nutrition. Our findings lead to several recommendations for addressing these challenges that should help improve women's experiences with DOTS TB treatment.
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Affiliation(s)
- Reshmi Mukerji
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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2
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Weld ED, Dooley KE. State-of-the-Art Review of HIV-TB Coinfection in Special Populations. Clin Pharmacol Ther 2018; 104:1098-1109. [PMID: 30137652 DOI: 10.1002/cpt.1221] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022]
Abstract
Children and pregnant and postpartum women experience an undue burden of HIV-associated tuberculosis (TB), but data are lacking on key aspects of their complex management. Often excluded from clinical trials, they are left with limited options for HIV-TB cotreatment. This review will focus on pharmacologic aspects of the treatment of HIV-TB coinfection in the special populations of children and pregnant and postpartum women. Pharmacogenomic considerations, rational dosing, drug-drug interactions, safety, immune reconstitution inflammatory syndrome, and ethical and policy aspects of the inclusion of special populations in research will be surveyed. Considerations related to the treatment of both HIV-associated TB disease and HIV-associated latent TB infection will be summarized. Relevant knowledge gaps and research priorities in special populations will be outlined.
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Affiliation(s)
- Ethel D Weld
- Division of Clinical Pharmacology, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Dooley
- Division of Clinical Pharmacology, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dennis EM, Hao Y, Tamambang M, Roshan TN, Gatlin KJ, Bghigh H, Ogunyemi OT, Diallo F, Spooner KK, Salemi JL, Olaleye OA, Khan KZ, Aliyu MH, Salihu HM. Tuberculosis during pregnancy in the United States: Racial/ethnic disparities in pregnancy complications and in-hospital death. PLoS One 2018; 13:e0194836. [PMID: 29579086 PMCID: PMC5868821 DOI: 10.1371/journal.pone.0194836] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background Despite decades of efforts to eliminate tuberculosis (TB) in the United States (US), TB still contributes to adverse ill health, especially among racial/ethnic minorities. According to the Centers for Disease Control and Prevention, in 2016, about 87% of the TB cases reported in the US were among racial and ethnic minorities. The objective of this study is to explore the risks for pregnancy complications and in-hospital death among mothers diagnosed with TB across racial/ethnic groups in the US. Methods This retrospective cohort study utilized National Inpatient Sample data for all inpatient hospital discharges in the US. We analyzed pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014 (n = 57,393,459). Multivariable logistic regression was applied to generate odds ratios for the association between TB status and the primary study outcomes (i.e., pregnancy complications and in-hospital death) across racial/ethnic categories. Results The prevalence of TB was 7.1 per 100,000 pregnancy-related hospitalizations. The overall prevalence of pregnancy complications was 80% greater among TB-infected mothers than their uninfected counterparts. Severe pre-eclampsia, eclampsia, placenta previa, post-partum hemorrhage, sepsis and anemia occurred with greater frequency among mothers with a TB diagnosis than those without TB, irrespective of race/ethnicity. The rate of in-hospital death among TB patients was 37 times greater among TB-infected than in non-TB infected mothers (468.8 per 100,000 versus 12.6 per 100,000). A 3-fold increased risk of in-hospital death was observed among black TB-negative mothers compared to their white counterparts. No racial/ethnic disparities in maternal morbidity or in-hospital death were found among mothers with TB disease. Conclusion TB continues to be an important cause of morbidity and mortality among pregnant women in the US. Resources to address TB disease should also target pregnant women, especially racial/ethnic minorities who bear the greatest burden of the disease.
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Affiliation(s)
- Erika M. Dennis
- Texas Southern University, Houston, Texas, United States of America
| | - Yun Hao
- Texas Southern University, Houston, Texas, United States of America
| | | | - Tasha N. Roshan
- Texas Southern University, Houston, Texas, United States of America
| | | | - Hanane Bghigh
- Texas Southern University, Houston, Texas, United States of America
| | | | - Fatoumata Diallo
- Texas Southern University, Houston, Texas, United States of America
| | - Kiara K. Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jason L. Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | | | - Kashif Z. Khan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Muktar H. Aliyu
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Hamisu M. Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
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Abstract
The issue of tuberculosis during pregnancy is not simply a historical inquiry but rather an increasingly familiar clinical problem facing industrial nations as well as the developing countries of the world. This review focuses on the maternal aspects of tuberculous infection, as well as transmission to the fetus and newborn.
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De Maio F, Trecarichi EM, Visconti E, Sanguinetti M, Delogu G, Sali M. Understanding cutaneous tuberculosis: two clinical cases. JMM Case Rep 2016; 3:e005070. [PMID: 28348793 PMCID: PMC5343121 DOI: 10.1099/jmmcr.0.005070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is an ancient human disease and remains today one of the most important public health problems and the second most frequent cause of death from an infectious disease worldwide. While pulmonary TB is the most common form, extra-pulmonary TB is on the rise due to the increase in immunosuppressed subjects. Cutaneous TB manifestations are rare forms of extra-pulmonary TB due to systemic dissemination of bacilli or direct inoculation, involving skin or skin-associated tissue, more common in immunocompromised subjects. Some risk factors and the features of the lesion may prompt the suspicion of cutaneous TB, but only microbiological assays can confirm the diagnosis. Our work summarizes cutaneous TB manifestations and differences from other skin mycobacterial infections, also describes two characteristic clinical cases.
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Affiliation(s)
- Flavio De Maio
- Insitute of Microbiology, Università Cattolica del Sacro Cuore , Rome , Italy
| | | | - Elena Visconti
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore , Rome , Italy
| | | | - Giovanni Delogu
- Insitute of Microbiology, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Michela Sali
- Insitute of Microbiology, Università Cattolica del Sacro Cuore , Rome , Italy
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Risk of Adverse Infant Outcomes Associated with Maternal Tuberculosis in a Low Burden Setting: A Population-Based Retrospective Cohort Study. Infect Dis Obstet Gynecol 2016; 2016:6413713. [PMID: 26989338 PMCID: PMC4771913 DOI: 10.1155/2016/6413713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
Background. Maternal tuberculosis (TB) may be associated with increased risk of adverse infant outcomes. Study Design. We examined the risk of low birth weight (LBW), small for gestational age (SGA), and preterm birth (<37 weeks) associated with maternal TB in a retrospective population-based Washington State cohort using linked infant birth certificate and maternal delivery hospitalization discharge records. We identified 134 women with births between 1987 and 2012 with TB-associated ICD-9 diagnosis codes at hospital delivery discharge and 536 randomly selected women without TB, frequency matched 4 : 1 on delivery year. Multinomial logistic regression analyses were performed to compare the risk of LBW, SGA, and preterm birth between infants born to mothers with and without TB. Results. Infants born to women with TB were 3.74 (aRR 95% CI 1.40–10.00) times as likely to be LBW and 1.96 (aRR 95% CI 0.91–4.22) as likely to be SGA compared to infants born to mothers without TB. Risk of prematurity was similar (aRR 1.01 95% CI 0.39–2.58). Conclusion. Maternal TB is associated with poor infant outcomes even in a low burden setting. A better understanding of the adverse infant outcomes associated with maternal TB, reflecting recent trends in US TB epidemiology, may inform potential targeted interventions in other low prevalence settings.
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Halder A, Vijayselvi R, Jose R. Changing perspectives of infectious causes of maternal mortality. J Turk Ger Gynecol Assoc 2015; 16:208-13. [PMID: 26692770 PMCID: PMC4664211 DOI: 10.5152/jtgga.2015.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/14/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Infections significantly contribute to maternal mortality. There is a perceived change in the spectrum of such infections. This study aims to estimate the contribution of various types of infections to maternal mortality. MATERIAL AND METHODS We retrospectively reviewed records of maternal death cases that took place between 2003 and 2012 in the Christian Medical College, Vellore, India. The International Classification of Diseases-Maternal Mortality was used to classify the causes of deaths and World Health Organization near-miss criteria were used to identify organ dysfunction that occurred before death. Infections during pregnancy were divided into three groups, i.e., pregnancy-related infections, pregnancy-unrelated infections, and nosocomial infections. RESULTS In this study, 32.53% of maternal deaths were because of some type of infection as the primary cause. The contribution of pregnancy-related infections was comparable with that of pregnancy-unrelated infections (16.03% vs. 16.50%). Metritis with pelvic cellulitis, septic abortions, tuberculosis, malaria, scrub typhus, and H1N1 influenza (influenza A virus subtype) were among the most commonly encountered causes of maternal death due to infections. Another 7.07% of cases developed severe systemic infection during the course of illness as nosocomial infection. A significant majority of mothers were below 30 years of age, were primiparae, had advanced gestational age, and had operative delivery. Cardiovascular and respiratory system dysfunctions were the most common organ dysfunctions encountered. CONCLUSION The contribution of pregnancy-unrelated infections to maternal deaths is significant. Control of these diverse community-acquired infections holds the key to a reduction in maternal mortality along with the promotion of clean birthing practices. Nosocomial infections should not be underestimated as a contributor to maternal mortality.
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Affiliation(s)
- Ajay Halder
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, India
| | - Reeta Vijayselvi
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India
| | - Ruby Jose
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India
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8
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Mehta N, Chen K, Hardy E, Powrie R. Respiratory disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:598-611. [PMID: 25997564 DOI: 10.1016/j.bpobgyn.2015.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/16/2022]
Abstract
Many physiological and anatomical changes of pregnancy affect the respiratory system. These changes often affect the presentation and management of the various respiratory illnesses in pregnancy. This article focuses on several important respiratory issues in pregnancy. The management of asthma, one of the most common chronic illnesses in pregnancy, remains largely unchanged compared to the nonpregnant state. Infectious respiratory illness, including pneumonia and tuberculosis, are similarly managed in pregnancy with antibiotics, although special attention may be needed for antibiotic choices with more pregnancy safety data. When mechanical ventilation is necessary, consideration should be given to the maternal hemodynamics of pregnancy and fetal oxygenation. Maintaining maternal oxygen saturation above 95% is recommended to sustain optimal fetal oxygenation. Cigarette smoking has known risks in pregnancy, and current practice guidelines recommend offering cognitive and pharmacologic interventions to pregnant women to assist in smoking cessation.
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Affiliation(s)
- Niharika Mehta
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Kenneth Chen
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erica Hardy
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Raumond Powrie
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Espiritu N, Aguirre L, Jave O, Sanchez L, Kirwan DE, Gilman RH. Congenital transmission of multidrug-resistant tuberculosis. Am J Trop Med Hyg 2014; 91:92-5. [PMID: 24821847 PMCID: PMC4080578 DOI: 10.4269/ajtmh.13-0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022] Open
Abstract
This article presents a case of multidrug-resistant tuberculosis (TB) in a Peruvian infant. His mother was diagnosed with disseminated TB, and treatment commenced 11 days postpartum. The infant was diagnosed with TB after 40 days and died at 2 months and 2 days of age. Congenital transmission of TB to the infant was suspected, because direct postpartum transmission was considered unlikely; also, thorough screening of contacts for TB was negative. Spoligotyping confirmed that both mother and baby were infected with identical strains of the Beijing family (SIT1).
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Affiliation(s)
- Nora Espiritu
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Lino Aguirre
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Oswaldo Jave
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Luis Sanchez
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Daniela E Kirwan
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert H Gilman
- Department of Pediatrics, Hospital Nacional Dos de Mayo, Lima, Peru; Department of Pulmonology, Hospital Nacional Dos de Mayo, Lima, Peru; "Santa Martha" Health Centre, Ministerio de Salud (MINSA), Lima, Peru; Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom; Laboratory of the Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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10
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Lange C, Abubakar I, Alffenaar JWC, Bothamley G, Caminero JA, Carvalho ACC, Chang KC, Codecasa L, Correia A, Crudu V, Davies P, Dedicoat M, Drobniewski F, Duarte R, Ehlers C, Erkens C, Goletti D, Günther G, Ibraim E, Kampmann B, Kuksa L, de Lange W, van Leth F, van Lunzen J, Matteelli A, Menzies D, Monedero I, Richter E, Rüsch-Gerdes S, Sandgren A, Scardigli A, Skrahina A, Tortoli E, Volchenkov G, Wagner D, van der Werf MJ, Williams B, Yew WW, Zellweger JP, Cirillo DM. Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement. Eur Respir J 2014; 44:23-63. [PMID: 24659544 PMCID: PMC4076529 DOI: 10.1183/09031936.00188313] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence. This document summarises the current knowledge on the prevention, diagnosis and treatment of adults and children with MDR/XDR-TB and their contacts, and provides expert consensus recommendations on questions where scientific evidence is still lacking. TBNET consensus statement on the management of patients with MDR/XDR-TB has been released in theEur Respir Jhttp://ow.ly/uizRD
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Affiliation(s)
- Christoph Lange
- For the authors' affiliations see the Acknowledgements section
| | | | | | | | - Jose A Caminero
- For the authors' affiliations see the Acknowledgements section
| | | | - Kwok-Chiu Chang
- For the authors' affiliations see the Acknowledgements section
| | - Luigi Codecasa
- For the authors' affiliations see the Acknowledgements section
| | - Ana Correia
- For the authors' affiliations see the Acknowledgements section
| | - Valeriu Crudu
- For the authors' affiliations see the Acknowledgements section
| | - Peter Davies
- For the authors' affiliations see the Acknowledgements section
| | - Martin Dedicoat
- For the authors' affiliations see the Acknowledgements section
| | | | - Raquel Duarte
- For the authors' affiliations see the Acknowledgements section
| | - Cordula Ehlers
- For the authors' affiliations see the Acknowledgements section
| | - Connie Erkens
- For the authors' affiliations see the Acknowledgements section
| | - Delia Goletti
- For the authors' affiliations see the Acknowledgements section
| | - Gunar Günther
- For the authors' affiliations see the Acknowledgements section
| | - Elmira Ibraim
- For the authors' affiliations see the Acknowledgements section
| | - Beate Kampmann
- For the authors' affiliations see the Acknowledgements section
| | - Liga Kuksa
- For the authors' affiliations see the Acknowledgements section
| | - Wiel de Lange
- For the authors' affiliations see the Acknowledgements section
| | - Frank van Leth
- For the authors' affiliations see the Acknowledgements section
| | - Jan van Lunzen
- For the authors' affiliations see the Acknowledgements section
| | | | - Dick Menzies
- For the authors' affiliations see the Acknowledgements section
| | | | - Elvira Richter
- For the authors' affiliations see the Acknowledgements section
| | | | | | - Anna Scardigli
- For the authors' affiliations see the Acknowledgements section
| | - Alena Skrahina
- For the authors' affiliations see the Acknowledgements section
| | - Enrico Tortoli
- For the authors' affiliations see the Acknowledgements section
| | | | - Dirk Wagner
- For the authors' affiliations see the Acknowledgements section
| | | | - Bhanu Williams
- For the authors' affiliations see the Acknowledgements section
| | - Wing-Wai Yew
- For the authors' affiliations see the Acknowledgements section
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11
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Mathad JS, Bhosale R, Sangar V, Mave V, Gupte N, Kanade S, Nangude A, Chopade K, Suryavanshi N, Deshpande P, Kulkarni V, Glesby MJ, Fitzgerald D, Bharadwaj R, Sambarey P, Gupta A. Pregnancy differentially impacts performance of latent tuberculosis diagnostics in a high-burden setting. PLoS One 2014; 9:e92308. [PMID: 24658103 PMCID: PMC3962385 DOI: 10.1371/journal.pone.0092308] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/21/2014] [Indexed: 01/20/2023] Open
Abstract
Background Targeted screening for latent TB infection (LTBI) in vulnerable populations is a recommended TB control strategy. Pregnant women are at high risk for developing TB and likely to access healthcare, making pregnancy an important screening opportunity in developing countries. The sensitivity of the widely-used tuberculin skin test (TST), however, may be reduced during pregnancy. Methods We performed a cross-sectional study comparing the TST with the QuantiFERON Gold In-tube (QGIT) in 401 HIV-negative women presenting antepartum (n = 154), at delivery (n = 148), or postpartum (n = 99) to a government hospital in Pune, India. A subset of 60 women enrolled during pregnancy was followed longitudinally and received both tests at all three stages of pregnancy. Results The QGIT returned significantly more positive results than the TST. Of the 401 women in the cross-sectional study, 150 (37%) had a positive QGIT, compared to 59 (14%) for the TST (p<0.005). Forty-nine (12%) did not have their TST read. Of 356 who had both results available, 46 (13%) were concordant positive, 91 (25%) were discordant (12 (3%) TST+/QGIT-; 79 (22%) TST−/QGIT+), and 206 (57%) concordant negative. Comparison by stage of pregnancy revealed that QGIT percent positivity remained stable between antepartum and delivery, unlike TST results (QGIT 31–32% vs TST 11–17%). Median IFN-γ concentration was lower at delivery than in antepartum or postpartum (1.66 vs 2.65 vs 8.99 IU/mL, p = 0.001). During postpartum, both tests had significantly increased positives (QGIT 31% vs 32% vs 52%, p = 0.01; TST 17% vs 11% vs 25%, p<0.005). The same trends were observed in the longitudinal subset. Conclusions Timing and choice of LTBI test during pregnancy impact results. QGIT was more stable and more closely approximated the LTBI prevalence in India. But pregnancy stage clearly affects both tests, raising important questions about how the complex immune changes brought on by pregnancy may impact LTBI screening.
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Affiliation(s)
- Jyoti S. Mathad
- Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail: (JSM); (AG)
| | - Ramesh Bhosale
- Department of Obstetrics and Gynaecology, Byramjee Jeejeebhoy Government Medical College- Sassoon General Hospital, Pune, Maharashtra, India
| | - Vikrant Sangar
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Savita Kanade
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Ashwini Nangude
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Kavita Chopade
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Marshall J. Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America
| | - Daniel Fitzgerald
- Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America
| | - Renu Bharadwaj
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College- Sassoon General Hospital, Pune, Maharashtra, India
| | - Pradeep Sambarey
- Department of Obstetrics and Gynaecology, Byramjee Jeejeebhoy Government Medical College- Sassoon General Hospital, Pune, Maharashtra, India
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (JSM); (AG)
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12
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Mathad JS, Gupta A. Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps. Clin Infect Dis 2012; 55:1532-49. [PMID: 22942202 PMCID: PMC3491857 DOI: 10.1093/cid/cis732] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/16/2012] [Indexed: 12/25/2022] Open
Abstract
Tuberculosis is most common during a woman's reproductive years and is a major cause of maternal-child mortality. National guidelines for screening and management vary widely owing to insufficient data. In this article, we review the available data on (1) the global burden of tuberculosis in women of reproductive age; (2) how pregnancy and the postpartum period affect the course of tuberculosis; (3) how to screen and diagnose pregnant and postpartum women for active and latent tuberculosis; (4) the management of active and latent tuberculosis in pregnancy and the postpartum period, including the safety of tuberculosis medications; and (5) infant outcomes. We also include data on HIV/tuberculosis coinfection and drug-resistant tuberculosis. Finally, we highlight research gaps in tuberculosis in pregnant and postpartum women.
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Affiliation(s)
- Jyoti S Mathad
- Division of Infectious Diseases, Weill Cornell Medical College, New York, New York 10065, USA.
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13
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Awodele O, Patrick EB, Oluwatoyin Agbaje E, Oremosu AA, Gbotolorun SC. Assessing the risk of birth defects associated with exposure to fixed-dose combined antituberculous agents during pregnancy in rats. ScientificWorldJournal 2012; 2012:585094. [PMID: 22629151 PMCID: PMC3354680 DOI: 10.1100/2012/585094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 12/20/2011] [Indexed: 11/17/2022] Open
Abstract
Due to the risks of disease progression and transmission to the newborn, treatment of tuberculosis is often pursued during pregnancy and fixed-dose combined antituberculous agents have been found to be beneficial. Unfortunately, there is paucity of data on the safety of the fixed-dose combined antituberculous drugs during pregnancy. This study intends to assess the teratogenic effect of fixed-dose combined antituberculous drugs on the organogenesis stage of fetal development and also investigate the possible roles of vitamin C in modulating the teratogenic effects of these agents on the fetus using animal model. Pregnant rats were divided into 3 groups with 12 animals per group: group 1 received distilled water (10 mL/kg) orally; group 2 received 51.4 mg/kg/day of fixed-dose combined antituberculous agents orally; group 3 received 51.4 mg/kg/day of fixed-dose combined antituberculous agents plus vitamin C (10 mg/kg/day) orally. Six rats in each group were randomly selected and sacrificed on day 20 by cervical dislocation prior to day 21 of gestation, and the foetuses were harvested through abdominal incision for physical examination. Blood samples were collected from the 1st filial rats of the remaining six animals for biochemical and hematological examination. The liver, kidney, heart, and brain of all the sacrificed animals were used for histopathological examination. There were significant (P ≤ 0.05) low birth weights of the foetuses of the animals that were treated with fixed-dose combined antituberculous agents. The haematological parameters also revealed a reduction in the platelets counts and neutrophiles at the first filial generation. Significant (P ≤ 0.05) elevations in the levels of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in the foetuses of the animals treated with fixed-dose combined antituberculous agents were also observed. However, the combination of vitamin C with fixed-dose combined antituberculous agents significantly (P ≤ 0.05) reduced the level of AST. Fixed-dose combined antituberculous agents have teratogenic potential as shown in low birth weight and mild liver damage in the first filial of the treated animals. As much as it is imminent to treat TB patients in pregnancy, there is need to always exercise caution and clinically weigh the risk-benefit ratio.
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Affiliation(s)
- O Awodele
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba 12003, Lagos, Nigeria.
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14
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Abstract
Tuberculosis (TB) was declared a public health emergency by WHO in 2005. The disease is a significant contributor to maternal mortality and is among the three leading causes of death among women aged 15-45 years in high burden areas. The exact incidence of tuberculosis in pregnancy, though not readily available, is expected to be as high as in the general population. Diagnosis of tuberculosis in pregnancy may be challenging, as the symptoms may initially be ascribed to the pregnancy, and the normal weight gain in pregnancy may temporarily mask the associated weight loss. Obstetric complications of TB include spontaneous abortion, small for date uterus, preterm labour, low birth weight, and increased neonatal mortality. Congenital TB though rare, is associated with high perinatal mortality. Rifampicin, INH and Ethambutol are the first line drugs while Pyrazinamide use in pregnancy is gaining popularity. Isoniazid preventive therapy is a WHO innovation aimed at reducing the infection in HIV positive pregnant women. Babies born to this mother should be commenced on INH prophylaxis for six months, after which they are vaccinated with BCG if they test negative. Successful control of TB demands improved living conditions, public enlightenment, primary prevention of HIV/AIDS and BCG vaccination.
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15
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HIV-Associated Tuberculosis in the Newborn and Young Infant. Int J Pediatr 2011; 2011:354208. [PMID: 21541068 PMCID: PMC3083848 DOI: 10.1155/2011/354208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 02/06/2011] [Indexed: 11/18/2022] Open
Abstract
Each year, approximately 250 000 women die during pregnancy, delivery, or postpartum. Maternal mortality rates due to tuberculosis (TB) and HIV in Sub-Saharan Africa now supersede obstetric-related causes of mortality. The majority of cases occur in population-dense regions of Africa and Asia where TB is endemic. The vertical transmission rate of tuberculosis is 15%, the overall vertical transmission rate of HIV in resource-limited settings with mono- or dual-ARV therapy varies from 1.9% to 10.7%. If the millennium development goals are to be achieved, both HIV and TB must be prevented. The essential aspect of TB prevention and detection in the newborn is the maternal history and a positive HIV status in the mother. Perinatal outcomes are guarded even with treatment of both diseases. Exclusive breast feeding is recommended. The community and social impact are crippling. The social issues aggravate the prognosis of these two diseases.
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Kwan BCH, Yu Y, Goldberg H. A case of tuberculosis in a pregnant woman and review of current literature. Obstet Med 2010; 3:161-3. [PMID: 27579084 PMCID: PMC4989625 DOI: 10.1258/om.2010.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2010] [Indexed: 05/30/2024] Open
Abstract
Tuberculosis (TB) in pregnancy can present with non-pulmonary symptoms, making diagnosis and treatment challenging. We present a case of TB in a pregnant woman and review current management recommendations.
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Affiliation(s)
- B C H Kwan
- Department of Respiratory Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
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17
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Sheriff FG, Manji KP, Manji MP, Chagani MM, Mpembeni RM, Jusabani AM, Alwani ZR, Karimjee TS. Latent tuberculosis among pregnant mothers in a resource poor setting in Northern Tanzania: a cross-sectional study. BMC Infect Dis 2010; 10:52. [PMID: 20205938 PMCID: PMC2846946 DOI: 10.1186/1471-2334-10-52] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 03/07/2010] [Indexed: 11/10/2022] Open
Abstract
Background Untreated latent TB infection (LTBI) is a significant risk factor for active pulmonary tuberculosis, hence predisposing to adverse pregnancy outcomes and mother to child transmission. The prevalence of latent tuberculosis in pregnancy and its association, if any, with various socio-demographic, obstetric and clinical characteristics was evaluated. Methods Northern Tanzania was chosen as the study site. In a cross-sectional study, a total of 286 pregnant women from 12 weeks gestational age to term were assessed. Screening was undertaken using an algorithm involving tuberculin skin testing, symptom screening in the form of a questionnaire, sputum testing for acid fast bacilli followed by shielded chest X-rays if indicated. HIV serology was also performed on consenting participants. Results Prevalence of latent infection ranged between 26.2% and 37.4% while HIV sero prevalence was 4.5%. After multivariate logistic analysis it was found that age, parity, body mass index, gestational age, and HIV sero status did not have any significant association with tuberculin skin test results. However certain ethnic groups were found to be less vulnerable to LTBI as compared to others (Chi square = 10.55, p = 0.03). All sputum smears for acid fast bacilli were negative. Conclusion The prevalence of latent tuberculosis in pregnant women was found to be relatively high compared to that of the general population. In endemic areas, socio-demographic parameters alone are rarely adequate in identifying women susceptible to TB infection; therefore targeted screening should be conducted for all pregnant women at high risk for activation (especially HIV positive women). As opposed to the current policy of passive case detection, there appears to be an imminent need to move towards active screening. Ethnicity may provide important clues into genetic and cultural differences which predispose to latent tuberculosis, and is worth exploring further.
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Affiliation(s)
- Faheem G Sheriff
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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18
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Al Jahdali HH, Baharoon S, Abba AA, Memish ZA, Alrajhi AA, AlBarrak A, Haddad QA, Al Hajjaj M, Pai M, Menzies D. Saudi guidelines for testing and treatment of latent tuberculosis infection. Ann Saudi Med 2010; 30:38-49. [PMID: 20103957 PMCID: PMC2850181 DOI: 10.4103/0256-4947.59373] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pulmonary tuberculosis is a common disease in Saudi Arabia. As most cases of tuberculosis are due to reactivation of latent infection, identification of individuals with latent tuberculosis infection (LTBI) who are at increased risk of progression to active disease, is a key element of tuberculosis control programs. Whereas general screening of individuals for LTBI is not cost-effective, targeted testing of individuals at high risk of disease progression is the right approach. Treatment of those patients with LTBI can diminish the risk of progression to active tuberculosis disease in the majority of treated patients. This statement is the first Saudi guideline for testing and treatment of LTBI and is a result of the cooperative efforts of four local Saudi scientific societies. This Guideline is intended to provide physicians and allied health workers in Saudi Arabia with the standard of care for testing and treatment of LTBI.
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Affiliation(s)
- Hamdan H Al Jahdali
- Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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19
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Whittaker E, Kampmann B. Perinatal tuberculosis: new challenges in the diagnosis and treatment of tuberculosis in infants and the newborn. Early Hum Dev 2008; 84:795-9. [PMID: 18823726 DOI: 10.1016/j.earlhumdev.2008.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With increasing rates of tuberculosis (TB) infection and disease worldwide, the rate of perinatal TB is also affected. A high index of suspicion by health professionals, in both the developed and developing world, is required to detect and manage tuberculosis in pregnancy and the early newborn period. Differences in immune responses in the fetus and neonate add to the diagnostic difficulties already recognised in young children. Although specific guidelines for the treatment of this potentially devastating disease are lacking due to paucity of experience, outcome is favourable, if the condition is recognised and treated according to existing TB protocols. HIV co-infection, multi- and extensively-drug resistant (MDR/XDR) TB contribute to the challenges. New diagnostic and vaccine developments hold future promise, but much work is needed to completely understand the complex immune responses to tuberculosis and control this disease.
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Affiliation(s)
- Elizabeth Whittaker
- Academic Department of Paediatrics, Imperial College London, United Kingdom.
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20
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Tabarsi P, Baghaei P, Mirsaeidi M, Amiri M, Mansouri D, Novin A, Zendedel SM, Masjedi MR. Multi-drug resistant tuberculosis in pregnancy: need for more intensive treatment. Infection 2007; 35:477-8. [PMID: 17906837 DOI: 10.1007/s15010-007-6318-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 05/24/2007] [Indexed: 10/22/2022]
Affiliation(s)
- P Tabarsi
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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21
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Gonçalves Marcos IAC. [Pregnancy and lungs]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2007; 13:213-37. [PMID: 17492234 DOI: 10.1016/s0873-2159(15)30345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Respiratory pathology can be relatively frequent during pregnancy. One third of pregnant woman may experience worsening of their asthma condition. Pulmonary tromboembolism is 5 times more frequent in pregnancy. Bacterial, viral and fungal pneumonias are badly tolerated during pregnancy, provoking mother-foetal morbidity, respiratory insufficiency, low born-weight or prematurity. Non-treated tuberculosis may increase maternal mortality and preterm birth by 4 and 9 times respectively. Pregnancy is counter-indicated in women with cystic fibrosis and severe pulmonary function. Despite therapeutic progresses already made, pulmonary hypertension is associated to over 30% of mother-foetal morbidity and mortality. Approximately 1 in 1,000-1,500 pregnancies is affected by mother cancer. High rates of lung cancer morbility in women bring new and important challenges to therapy.
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22
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McCarthy FP, Rowlands S, Giles M. Tuberculosis in pregnancy - case studies and a review of Australia's screening process. Aust N Z J Obstet Gynaecol 2007; 46:451-5. [PMID: 16953862 DOI: 10.1111/j.1479-828x.2006.00633.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Few changes have occurred in the management of tuberculosis over the past two decades and many of the recent developments are in the area of diagnostics. The application of these to the pregnant population is not yet established. Two cases recently managed at the Royal Women's Hospital, Melbourne highlight the need for clinicians managing pregnant women to rethink this condition and, with changes in migration and epidemiology, reconsider our screening practice.
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Affiliation(s)
- Fergus P McCarthy
- Obstetrics Department, Royal Women's Hospital, Carlton, Victoria, Australia.
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23
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Drobac PC, del Castillo H, Sweetland A, Anca G, Joseph JK, Furin J, Shin S. Treatment of Multidrug-Resistant Tuberculosis during Pregnancy: Long-Term Follow-Up of 6 Children with Intrauterine Exposure to Second-Line Agents. Clin Infect Dis 2005; 40:1689-92. [PMID: 15889370 DOI: 10.1086/430066] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 01/24/2005] [Indexed: 11/03/2022] Open
Abstract
Treatment of gestational multidrug-resistant tuberculosis (MDR-TB) is controversial. We describe follow-up of 6 children exposed to second-line antituberculous agents in utero. Each child (average age, 3.7 years) underwent comprehensive clinical evaluation. One child had MDR-TB diagnosed. There was no evidence of significant late-presentation toxicity among the children. The results suggest that aggressive management of gestational MDR-TB may benefit both mother and child.
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Affiliation(s)
- Peter C Drobac
- Department of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, MA 02120, USA.
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24
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Madkour MM. Tuberculosis and Pregnancy. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Cheng VCC, Woo PCY, Lau SKP, Cheung CHY, Yung RWH, Yam LYC, Yuen KY. Peripartum tuberculosis as a form of immunorestitution disease. Eur J Clin Microbiol Infect Dis 2003; 22:313-7. [PMID: 12743831 DOI: 10.1007/s10096-003-0927-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to assess the clinical spectrum of peripartum tuberculosis from the perspective of immunorestitution disease. Of 29 patients with peripartum tuberculosis, 27 (93.1%) had extrapulmonary tuberculosis, 20 (69%) of whom were affected in the central nervous system. Twenty-two (75.9%) patients had no clinical features suggestive of tuberculosis during pregnancy. The median time from delivery to the onset of immunorestitution was 4 days, but treatment with anti-tuberculous therapy was delayed for a median time of 27 days after the onset of symptoms. Despite therapy, 11 (38%) patients died and 4 (13.8%) had residual functional deficits. Peripartum tuberculosis is an important differential diagnosis of postpartum fever (of unknown origin) without localized signs.
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Affiliation(s)
- V C C Cheng
- Division of Infectious Diseases, Center of Infection, Queen Mary Hospital, The University of Hong Kong, University Pathology Building, Hong Kong
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26
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Shin S, Guerra D, Rich M, Seung KJ, Mukherjee J, Joseph K, Hurtado R, Alcantara F, Bayona J, Bonilla C, Farmer P, Furin J. Treatment of multidrug-resistant tuberculosis during pregnancy: a report of 7 cases. Clin Infect Dis 2003; 36:996-1003. [PMID: 12684912 DOI: 10.1086/374225] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2002] [Accepted: 01/16/2003] [Indexed: 11/03/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a global public health problem affecting women of childbearing age. Little is known, however, about the safety of the drugs used to treat MDR-TB during pregnancy. We describe 7 patients who were treated for MDR-TB during pregnancy. These patients had chronic tuberculosis that had caused extensive parenchymal damage and had high-grade resistance to antituberculous drugs. All patients received individualized antituberculous therapy prior to delivery of healthy term infants. Neither obstetrical complications nor perinatal transmission of MDB-TB was observed. One patient experienced treatment failure, and another abandoned therapy. The other 5 patients are currently cured or in treatment and have culture-negative status. In each of these 7 cases, excellent treatment outcomes were obtained for the women and their children. Under certain circumstances, MDR-TB can be successfully treated during pregnancy.
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Affiliation(s)
- Sonya Shin
- Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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27
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Lessnau KDKL, Qarah S. Multidrug-resistant tuberculosis in pregnancy: case report and review of the literature. Chest 2003; 123:953-6. [PMID: 12628902 DOI: 10.1378/chest.123.3.953] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A woman at 23 weeks' gestation was treated with rifampin, isoniazid, and ethambutol for cavitary tuberculosis (TB). She did not respond within 3 weeks, and multidrug-resistant (MDR) TB was suspected. Direct plating on susceptibility media was performed immediately. Treatment was initiated with IV capreomycin, levofloxacin, para-aminosalicylic acid, pyrazinamide, cycloserine, and high-dose vitamin B(6) at 26 weeks' gestation. The patient delivered vaginally at week 35. The newborn was not infected. Following delivery, ethionamide was added as a sixth drug, and levofloxacin was replaced with moxifloxacin. The patient's sputum became smear-negative and culture-negative for TB. All reported cases of MDR-TB during pregnancy are reviewed.
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28
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Burke SDA, Sawchuk LA. Tuberculosis mortality and recent childbirth: a retrospective case-control study of Gibraltarian women, 1874-1884. Soc Sci Med 2003; 56:477-90. [PMID: 12570968 DOI: 10.1016/s0277-9536(02)00048-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Prior to the introduction of effective treatment for pulmonary tuberculosis, there was little consensus on the potential health risk of pregnancy among infected women. While, intuitively, pregnancy was viewed as a risk for tuberculosis disease and mortality, early studies could not establish such a link with any great certainty. Our case study combines the methods of family reconstitution and a case-control approach to explore the possibility that the physiological and social strains of recent childbirth and the early mothering of infants may have been risk factors in adult female tuberculosis mortality in late 19th-century Gibraltar. The study is based on 244 reproductive age women who died between 1874 and 1884; some 55% of these deaths were attributed to tuberculosis. The record linkage indicates that almost 12% of the women who died had given birth within the year preceding their death. Factoring in the effects of age at death, marital status, and religion, the logistic regression results indicate that recent childbirth did not increase the risk of tuberculosis mortality among these women.
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Affiliation(s)
- Stacie D A Burke
- Department of Anthropology, McMaster University, 1280 Main Street West, Ont., L8S 4L9, Hamilton, Canada.
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29
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Abstract
Untreated tuberculosis in pregnancy poses a significant threat to the mother, fetus and family. Adherence to treatment is especially difficult in pregnancy because of the general fear of any medication and pregnancy-related nausea. Supervised treatment is especially helpful in encouraging adherence. All 4 first line drugs [isoniazid, rifampicin (rifampin), ethambutol and pyrazinamide] have an excellent safety record in pregnancy and are not associated with human fetal malformations. Drug-induced hepatitis, especially with isoniazid, is a significant problem in treating tuberculosis, not peculiar to pregnancy; close monitoring of liver function is recommended. Liver enzyme induction by rifampicin alters the metabolism of other drugs, e.g. methadone doses will need to be increased. Streptomycin should not be used in pregnancy, as perhaps 1 in 6 babies will have problems with hearing and/or balance. Ciprofloxacin has the best safety profile of second line drugs in the treatment of drug-resistant tuberculosis. Preventive treatment with isoniazid can be undertaken safely during pregnancy. Pyridoxine (vitamin B6) should be added to the drug treatment of tuberculosis in all pregnant women taking isoniazid. Neither tuberculin nor the bacille Calmette Guérin (BCG) vaccine are treatments for tuberculosis, but they play an important role in the management of the disease. Tuberculin testing is safe, but BCG vaccination should be avoided in pregnancy and instead given earlier in life.
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Affiliation(s)
- G Bothamley
- East London Tuberculosis Service, Homerton Hospital, England.
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30
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Abstract
Although the advent of broad-spectrum antibiotics has markedly improved the maternal outcomes of pneumonia complicating pregnancy, pneumonia remains a significant condition that may complicate pregnancy. This article has reviewed the inherent physiologic respiratory changes that accompany pregnancy and the common causes of pneumonia in the pregnant woman. The clinical course of bacterial pneumonia seems to be minimally altered by pregnancy, whereas viral pneumonia carries a significantly worse prognosis when encountered during gestation. Prompt diagnosis, the initiation of respiratory support, and appropriate antimicrobial/antiviral therapy are key components of therapy for women in whom pregnancy is complicated by pneumonia. Because preterm labor frequently accompanies pneumonia, women should be monitored closely for the occult onset of preterm labor and appropriate interventions initiated if indicated. Perhaps even more important than interventions to treat acute pneumonia are efforts directed at active immunization or prophylactic therapy to prevent the development of pneumonia in select patient populations. The combination of these efforts is essential to optimize medical care for pregnant women.
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MESH Headings
- Female
- Humans
- Immunocompromised Host
- Lung Diseases, Fungal/microbiology
- Lung Diseases, Fungal/therapy
- Pneumonia/drug therapy
- Pneumonia/etiology
- Pneumonia/physiopathology
- Pneumonia, Aspiration
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/therapy
- Pneumonia, Viral/therapy
- Pneumonia, Viral/virology
- Pregnancy/physiology
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/etiology
- Pregnancy Complications, Infectious/physiopathology
- Respiratory Physiological Phenomena
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Affiliation(s)
- P S Ramsey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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31
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Affiliation(s)
- P Ormerod
- Chest Clinic, Blackburn Royal Infirmary, Blackburn BB2 3LR, Preston, UK
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32
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33
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Affiliation(s)
- P Bhatia
- Department of Respiratory Medicine, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
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Thillagavathie P. Current issues in maternal and perinatal tuberculosis: impact of the HIV-1 epidemic. SEMINARS IN NEONATOLOGY : SN 2000; 5:189-96. [PMID: 10956444 DOI: 10.1053/siny.2000.0022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Human immunodeficiency virus type 1 (HIV-1) and tuberculosis (TB) are among the leading causes of disability and death in the developing world, the largest burden borne by sub-Saharan Africa and Asia. Both diseases are significant among women of childbearing age, and TB, although uncommon in pregnancy, is on the increase. While earlier reports were contradictory regarding the effect of TB on the course of pregnancy and vice versa, the negative impacts of each on the other have been documented, some in relation to HIV-1 co-infection. This review focuses on emerging data on maternal and perinatal TB within the context of HIV-1 infection.
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Affiliation(s)
- P Thillagavathie
- Department of Paediatrics and Child Health, Medical School, University of Natal, Congella, Durban, 4013, South Africa.
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35
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Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000; 161:S221-47. [PMID: 10764341 DOI: 10.1164/ajrccm.161.supplement_3.ats600] [Citation(s) in RCA: 880] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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36
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Llewelyn M, Cropley I, Wilkinson RJ, Davidson RN. Tuberculosis diagnosed during pregnancy: a prospective study from London. Thorax 2000; 55:129-32. [PMID: 10639530 PMCID: PMC1745685 DOI: 10.1136/thorax.55.2.129] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A study was undertaken to characterise the presentation of tuberculosis in pregnancy and the difficulties in diagnosis in an area of the UK with a high incidence of tuberculosis. METHODS A prospective case series was investigated at Northwick Park Hospital, a university affiliated district general hospital in Brent and Harrow health authority in north-west London which incorporates a regional infectious diseases unit. Patients diagnosed with tuberculosis over the study period were included if the onset of symptoms occurred during pregnancy. RESULTS Thirteen patients were diagnosed during a 30 month period from December 1995 to May 1998 during which 9069 mothers were delivered, a prevalence of 143.3/100 000 deliveries. Symptoms began at a median of 22 weeks gestation (range 9-40 weeks). All patients were recent immigrants of Indian subcontinent or Somali origin and their median duration of residence in the UK was 31 months (range 1-72). Prevalence broken down for racial origin of mothers was 466.3/100 000 for mothers of black African origin and 239.1/100 000 for mothers of Indian origin. Nine of the 13 patients had extrapulmonary tuberculosis. Four patients with widely disseminated disease had a negative Mantoux response and five with localised disease had a strongly positive Mantoux response. HIV co-infection was absent. The median delay between the onset of symptoms and diagnosis was seven weeks (range 2-30). The response to standard treatment was excellent and all patients were cured. CONCLUSIONS Tuberculosis occurring in pregnancy is common in recent immigrants. Diagnosis during pregnancy is delayed because the disease is frequently extrapulmonary with few symptoms.
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Affiliation(s)
- M Llewelyn
- Wellcome Centre for Clinical Tropical Medicine, Imperial College School of Medicine, Northwick Park Hospital, Harrow HA1 3UJ, UK
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Al-Hajjaj MS, Al Haider AK, Islam MW. Evaluation of the teratogenic potential of pyrazinamide in Wistar rats. Ups J Med Sci 1999; 104:259-70. [PMID: 10680959 DOI: 10.3109/03009739909178969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We have tested Pyrazinamide (PZA), an essential component of modern short-course tuberculosis treatment regimen, for teratogenicity using Wistar rats. The drug was given by oral intubation from 6-15 days of gestation, at doses of 0, 25, 100 and 500 mg/kg body weight per day. Reduction in body weight and food consumption were observed in the treated dams. On day 20 of gestation, all the dams were killed by cervical dislocation and signs of maternal toxicity, reproductive indices and fetal measurements were recorded. Dams given doses of 100 and 500 mg/kg had significantly higher incidence of reabsorbed fetuses, reduced litter size, and impaired neonatal growth than those given no PZA or only 25 mg/kg dose. External visceral and skeletal examination of all fetuses of PZA-treated dams showed several types of variations which were neither dose related nor having a consistent pattern. However, these variations occurred mostly in the dams treated with the dose of 500 mg/kg. In conclusion, these data show that in Wistar rats, only high doses of PZA (100 and 500 mg/kg) produced fetotoxicity. No evidence of teratogenic effect of the drug was observed.
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Affiliation(s)
- M S Al-Hajjaj
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Antepartum pneumonia requires prompt evaluation and empiric antimicrobial therapy. The choice of antimicrobial therapy depends on maternal risk factors, symptoms, and clinical presentation. Although laboratory studies such as culture and serology should be obtained, they may not always yield a specific etiologic agent. However, prompt empiric treatment and supportive care should lead to good maternal and fetal outcomes. Similarly, in most cases, proper diagnosis and treatment of TB during pregnancy yield good maternal and fetal outcomes. TB screening is essential for the growing population of individuals with HIV infection and recent immigrants from areas where tuberculosis is endemic.
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Affiliation(s)
- L Riley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA
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Affiliation(s)
- K S Miller
- Respiratory Therapy Services Trident Regional Health System, Charleston, South Carolina 29406, USA
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Abstract
After years of decline, tuberculosis has again emerged as a serious public health issue. Following the introduction of effective chemotherapy at mid-century, cases of tuberculosis decreased until 1986. Since that time, the number of cases of tuberculosis have dramatically increased, particularly among young persons. The reemergence of tuberculosis is localized to urban areas and is linked to the increase in the incidence of human immunodeficiency virus infection and drug resistance. Since pregnant women are at risk for tubercular infection, an effective method exists to identify women who are asymptomatically infected, provide them with treatment to prevent progression of disease, and investigate their contacts. This review will discuss the issues of diagnosis and treatment of asymptomatic infection and active tuberculosis in pregnant women. Additionally, the need for universal screening of all prenatal patients and the benefit and potential perinatal toxicity of chemotherapy in both immunocompetent patients and those infected with human immunodeficiency virus will be addressed.
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MESH Headings
- Drug Resistance, Microbial
- Female
- HIV Infections/complications
- HIV Infections/epidemiology
- Humans
- Mass Screening
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/pathology
- Pregnancy Complications, Infectious/prevention & control
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/pathology
- Tuberculosis, Pulmonary/prevention & control
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Affiliation(s)
- C A Robinson
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philaldephia 19104, USA
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Malhotra D, Vasishta K, Srinivasan R, Singh G. Tuberculous uteroenterocutaneous fistula--a rare post-caesarean complication. Aust N Z J Obstet Gynaecol 1995; 35:342-4. [PMID: 8546664 DOI: 10.1111/j.1479-828x.1995.tb02002.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A case of uteroenterocutaneous fistula which developed after lower segment Caesarean section is described. A total abdominal hysterectomy with removal of a tuboovarian mass with excision of the fistulous tract and repair of a small gut fistula were performed. The tuberculous aetiology of this fistula was established after surgery by a positive endometrial culture of acid fast bacilli and the demonstration of epithelioid granulomas in the surgical specimen. Antituberculosis therapy was started and the postoperative recovery was uneventful. The description of the nature of the fistula, its rarity and its presence in a woman with unimpaired fertility are discussed.
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Affiliation(s)
- D Malhotra
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- P T Davidson
- Tuberculosis Control Program, Los Angeles County, CA, USA
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Abstract
Although recent studies have reported otherwise, previous conventional wisdom has held that one-half to two-thirds of pregnant women with tuberculosis are asymptomatic. If true, this has important implications for screening programs. Charts of all patients with culture-proven Mycobacterium tuberculosis in Rhode Island between 1987 and 1991 were reviewed. One-third of women aged 21 to 32 years with culture-proven tuberculosis were pregnant at time of diagnosis (7 pregnant; 15 nonpregnant). Pregnant patients with pulmonary conditions were more likely to be found through routine screening (p = 0.008) and to be asymptomatic (p = 0.008). In addition, pregnant women with pulmonary conditions were more likely to present with unilateral non-cavitary, smear-negative disease (p = 0.02). If routine screening is not performed prenatally with radiographic follow-up of all infected individuals, most pregnant women will not have their conditions diagnosed and, therefore, will not be treated in time to prevent risk to the fetus, the newborn, and the obstetric ward.
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Affiliation(s)
- E J Carter
- Division of Pulmonary Medicine, Brown University School of Medicine, Roger Williams Medical Center, Providence, RI
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Affiliation(s)
- M A Hamadeh
- Northwestern University Medical School, Chicago
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McIntyre PB, McCormack JG, Vacca A. Tuberculosis in pregnancy--implications for antenatal screening in Australia. Med J Aust 1987; 146:42-4. [PMID: 3796394 DOI: 10.5694/j.1326-5377.1987.tb120125.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Two cases of tuberculosis have been seen over the past two years in southeast Asian women who had recently emigrated to Australia and who attended a single maternity hospital in Brisbane. One patient died of tuberculous meningitis and the other had an asymptomatic tuberculous pleural effusion. Both cases illustrate some of the difficulties in the diagnosis of extrapulmonary tuberculosis, particularly in pregnant women, and the low level of awareness of this condition. Antenatal screening for tuberculosis is not performed as a routine in Australia. Pregnant women who have emigrated recently from areas of high prevalence constitute a group at increased risk for tuberculosis who should be screened selectively with tuberculin tests and chest x-ray examinations.
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