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Rakanovic D, Sobot Novakovic S, Kantar M, Rakanovic S, Popovic I. Video-Assisted Thoracoscopic Surgery (VATS) in Pregnant Patient With Tuberculosis: A Case Report. Cureus 2024; 16:e67933. [PMID: 39328662 PMCID: PMC11426308 DOI: 10.7759/cureus.67933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Diagnosis of tuberculosis (TB) in pregnancy may be challenging. Recommended diagnostic tests often are not sensitive, and additional diagnostic procedures are necessary to confirm disease. Symptoms of TB in pregnancy are often atypical and difficult to diagnose in the early stages of the disease. Obstetric complications of TB include spontaneous abortion, preterm labor, low birth weight, and increased neonatal mortality. In pregnant patients, empyema is one of the complications of tuberculous pneumonia, and video-assisted thoracoscopic surgery (VATS) is the recommended surgical treatment. We present the case of a pregnant patient in the 20th week of gestation who was hospitalized due to suspected TB. Serological, microbiological, and molecular tests specific to TB were negative. Radiological tests confirmed pneumonia with pleural effusion. Due to the development of empyema, VATS debridement was indicated. VATS pleural biopsy confirmed the diagnosis of TB.
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Affiliation(s)
- Dragan Rakanovic
- Clinic for Anesthesiology and Intensive Therapy, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
- Faculty of Medicine, University of Banja Luka, Banja Luka, BIH
| | - Suzana Sobot Novakovic
- Clinic for Anesthesiology and Intensive Therapy, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
- Faculty of Medicine, University of Banja Luka, Banja Luka, BIH
| | - Marko Kantar
- Clinic for Thoracic Surgery, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Sanja Rakanovic
- Clinic for Anesthesiology and Intensive Therapy, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Ivana Popovic
- Clinic for Anesthesiology and Intensive Therapy, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
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Arvidsson Å, Lafta G, Sönnerbrandt M, Sundelin K, Paues J. The cascade of care for pregnant women with latent tuberculosis infection in a high-income country. Infect Dis (Lond) 2023; 55:635-645. [PMID: 37389825 DOI: 10.1080/23744235.2023.2228406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Pregnant women have an increased risk of developing active tuberculosis (TB). The Public Health Agency of Sweden recommends screening of active TB and latent tuberculosis infection (LTBI) among pregnant women from countries with high TB incidence at Maternal Health Care (MHC) clinics. In Östergötland County, Sweden, a screening program has been active since 2013. The aim of this study was to evaluate this screening program and the cascade of care for LTBI among pregnant women in Östergötland county. METHODS Data were obtained from pregnant women screened for TB at MHC clinics and subsequently referred to the pulmonary medicine clinic or the clinic of infectious diseases in Östergötland County between 2013 and 2018. The Public Health Agency of Sweden's national database for active TB was used to analyse if any women developed active TB up to two years after the screening process. RESULTS A total of 439 women were included. Nine cases of active TB were discovered during the screening process and two developed active TB afterward. 177 women were recommended LTBI treatment and variables significantly associated with a decreased likelihood of being recommended treatment were increasing age, time in Sweden, and parity. 137 women received and 112 (82%) completed treatment. 14 women discontinued treatment due to adverse effects. CONCLUSION Screening of pregnant women from countries with high TB incidence at MHC clinics led to the discovery of several cases of active TB. The completion rate of LTBI treatment was high and few discontinued due to adverse effects.
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Affiliation(s)
- Åsa Arvidsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gihan Lafta
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Karin Sundelin
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
| | - Jakob Paues
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
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3
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Jones AJ, Mathad JS, Dooley KE, Eke AC. Evidence for Implementation: Management of TB in HIV and Pregnancy. Curr HIV/AIDS Rep 2022; 19:455-470. [PMID: 36308580 PMCID: PMC9617238 DOI: 10.1007/s11904-022-00641-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Pregnant people living with HIV (PLWH) are at especially high risk for progression from latent tuberculosis infection (LTBI) to active tuberculosis (TB) disease. Among pregnant PLWH, concurrent TB increases the risk of complications such as preeclampsia, intrauterine fetal-growth restriction, low birth weight, preterm-delivery, perinatal transmission of HIV, and admission to the neonatal intensive care unit. The grave impact of superimposed TB disease on maternal morbidity and mortality among PLWH necessitates clear guidelines for concomitant therapy and an understanding of the pharmacokinetics (PK) and potential drug-drug interactions (DDIs) between antitubercular (anti-TB) agents and antiretroviral therapy (ART) in pregnancy. RECENT FINDINGS This review discusses the currently available evidence on the use of anti-TB agents in pregnant PLWH on ART. Pharmacokinetic and safety studies of anti-TB agents during pregnancy and postpartum are limited, and available data on second-line and newer anti-TB agents used in pregnancy suggest that several research gaps exist. DDIs between ART and anti-TB agents can decrease plasma concentration of ART, with the potential for perinatal transmission of HIV. Current recommendations for the treatment of LTBI, drug-susceptible TB, and multidrug-resistant TB (MDR-TB) are derived from observational studies and case reports in pregnant PLWH. While the use of isoniazid, rifamycins, and ethambutol in pregnancy and their DDIs with various ARTs are well-characterized, there is limited data on the use of pyrazinamide and several new and second-line antitubercular drugs in pregnant PLWH. Further research into treatment outcomes, PK, and safety data for anti-TB agent use during pregnancy and postpartum is urgently needed.
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Affiliation(s)
- Amanda J Jones
- Department of Obstetrics & Gynecology, Christiana Care Health Services, 4755 Ogletown Stanton Road, Newark, DE, 19713, USA
| | - Jyoti S Mathad
- Center for Global Health, Department of Medicine and Obstetrics & Gynecology, Weill Cornell Medicine, 402 E 67th Street, 2nd floor, New York, NY, 10021, USA
| | - Kelly E Dooley
- Division of Clinical Pharmacology & Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Ahizechukwu C Eke
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 228, Baltimore, MD, 21287, USA.
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Moscibrodzki P, Enane LA, Hoddinott G, Brooks MB, Byron V, Furin J, Seddon JA, Meyersohn L, Chiang SS. The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults. Pathogens 2021; 10:1591. [PMID: 34959546 PMCID: PMC8706072 DOI: 10.3390/pathogens10121591] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 01/26/2023] Open
Abstract
The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience. This review summarizes the evidence of the impact of TB disease and treatment on these five domains of AYA well-being.
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Affiliation(s)
- Patricia Moscibrodzki
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Virginia Byron
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
- Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, MA 02115, USA
| | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Lily Meyersohn
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
| | - Silvia S. Chiang
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA
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5
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Ma H, Sun J, Zhang L, Liu Y, Liu H, Wu X, Guo L. Disseminated Hematogenous Tuberculosis Following in vitro Fertilization-Embryo Transfer: A Case Report. Infect Drug Resist 2021; 14:4903-4911. [PMID: 34853518 PMCID: PMC8627859 DOI: 10.2147/idr.s332992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to analyze the diagnosis and treatment process of patients with hematogenous disseminated pulmonary tuberculosis after treatment with in vitro fertilization-embryo transfer (IVF-ET). We retrospectively analyzed the clinical data, including imaging and etiological data, the use of antimicrobials, metagenomic next-generation sequencing (mNGS) results, and the treatment process, of a patient who underwent IVF-ET due to an obstruction in the fallopian tube; after the treatment, she developed a persistent fever with shortness of breath and suffered a spontaneous abortion. Due to the failure of other treatment modalities, fiber optic bronchoscopy was performed, and the alveolar lavage fluid was obtained for mNGS. Tests for Mycobacterium tuberculosis and rifampicin resistance (Xpert MTB/RIF) showed positive and negative results, respectively. Subsequently, anti-tuberculosis treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was administered. After the patient's condition improved, she was transferred to a specialized tuberculosis hospital for further treatment, where she died one month later from multiple organ failure. From this case, we conclude that clinicians should remain highly vigilant for pulmonary infection with M. tuberculosis in pregnant women, particularly in patients treated with IVF-ET, and check for its presence as soon as possible.
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Affiliation(s)
- Hongye Ma
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Jingjing Sun
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Lei Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Yu Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Hongjuan Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Xiaoling Wu
- Department of Critical Care Medicine, The Fifth People's Hospital of ShaanXi, Xi'an, ShaanXi, People's Republic of China
| | - Litao Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
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Orazulike N, Sharma JB, Sharma S, Umeora OUJ. Tuberculosis (TB) in pregnancy - A review. Eur J Obstet Gynecol Reprod Biol 2021; 259:167-177. [PMID: 33684671 DOI: 10.1016/j.ejogrb.2021.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
Tuberculosis (TB) is a common infectious pathology especially in low-income countries, which may complicate pregnancy. Although pulmonary TB is more common in pregnancy than extra pulmonary TB (EPTB), EPTB is becoming more common especially in those living with human deficiency virus (HIV) co infection or have other comorbidities. The diagnosis of TB may be delayed in pregnancy due to the masking of its symptoms by those of pregnancy. If diagnosed and treated on time both pulmonary TB and EPTB are associated with excellent maternal and perinatal outcome. If, however, there is delay in diagnosis and treatment then there could be adverse maternal and fetal consequences like preterm labour, fetal growth restriction and even stillbirths. Similarly severe forms of TB like disseminated disease (miliary TB) or multi drug resistant TB (MDR TB) are associated with poor outcome. Diagnosis and management is same as in non-pregnant patients. Both drug sensitive pulmonary TB and EPTB are treated with four drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) orally daily for 2 months followed by three drugs (isoniazid, rifampicin and ethambutol) orally daily for 4 months. Drug resistant TB is treated with second line drugs with caution, as some of these drugs are teratogenic. Optimum antenatal care and nutrition therapy along with anti-tuberculosis drugs provide for optimum maternal and perinatal outcome. This review discusses maternal and perinatal outcomes, diagnosis and management of pulmonary TB and extrapulmonary TB as well as perinatal tuberculosis.
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Affiliation(s)
- Ngozi Orazulike
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
| | - J B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Odidika U J Umeora
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
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7
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Increased risk of hepatotoxicity and temporary drug withdrawal during treatment of active tuberculosis in pregnant women. Int J Infect Dis 2020; 98:138-143. [DOI: 10.1016/j.ijid.2020.06.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
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Pasipamire M, Broughton E, Mkhontfo M, Maphalala G, Simelane-Vilane B, Haumba S. Detecting tuberculosis in pregnant and postpartum women in Eswatini. Afr J Lab Med 2020; 9:837. [PMID: 32832404 PMCID: PMC7433265 DOI: 10.4102/ajlm.v9i1.837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 04/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background Tuberculosis diagnosis in pregnancy is complex because tuberculosis symptoms are often masked by physiological symptoms of pregnancy. Untreated tuberculosis in pregnant and postpartum women may lead to maternal morbidity and low birth weight. Tuberculosis in HIV-positive pregnant women increases the risk of maternal and infant mortality. Objective This study aimed to determine tuberculosis prevalence stratified by HIV status and identify screening algorithms that maximise detection of active tuberculosis among pregnant and postpartum women in Eswatini. Methods Women were enrolled at antenatal and postnatal clinics in Eswatini for tuberculosis screening and diagnostic investigations from 01 April to 30 November 2015 in a cross-sectional study. Sputum samples were collected from all participants for tuberculosis diagnostic tests (smear microscopy, GeneXpert, MGIT culture). Blood and urine samples were collected from HIV-positive women for cluster-of-differentiation-4 cell count, interferon gamma release assay and tuberculosis lateral flow urine lipoarabinomannan tests. Results We enrolled 990 women; 52% were pregnant and 47% were HIV-positive. The prevalence of tuberculosis among HIV-positive pregnant women was 5% (95% confidence interval [CI]: 2-7) and among postpartum women it was 1% (95%CI: -1-3). Tuberculosis prevalence was 2% (95%CI: 0-3) in HIV-negative pregnant women and 1% (95%CI: -1-2) in HIV-negative postpartum women. The national tuberculosis symptom screening tool failed to identify women who tested tuberculosis-culture positive. Conclusion Routine tuberculosis symptom screening alone is insufficient to rule out tuberculosis in pregnant and postpartum women. Only sputum culture maximised the detection of tuberculosis, indicating a need to balance access and cost in developing countries.
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Affiliation(s)
- Munyaradzi Pasipamire
- Research and Evaluation, Eswatini National AIDS Programme, Ministry of Health, Mbabane, Eswatini
| | - Edward Broughton
- Research and Evaluation, University Research Co. LLC, Chevy Chase, Maryland, United States.,International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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Li Q, Song Y, Chen H, Xie L, Gao M, Ma L, Huang Y. Retrospective Analysis of 28 Cases of Tuberculosis in Pregnant Women in China. Sci Rep 2019; 9:15347. [PMID: 31653911 PMCID: PMC6814810 DOI: 10.1038/s41598-019-51695-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/01/2019] [Indexed: 12/19/2022] Open
Abstract
While tuberculosis (TB) in pregnant women is reported globally, clinical data is unavailable in China. To describe clinical features and identify difficulties in the diagnosis of pregnancy-related TB, we performed a retrospective study of 28 TB inpatients at Beijing Chest Hospital. The results were presented in terms of interquartile range (IQR) for age, and medians and percentages with respect to the categorical variables. One patient (3.6%) was immediately diagnosed; for 27 patients (96.4%), the median interval from the initial onset of symptoms to diagnosis was five weeks. Eight cases (28.6%) were microbiologically confirmed. 22 (78.6%) were pulmonary TB (PTB), while six (21.4%) were extrapulmonary TB (EPTB). In addition, eight (28.6%) were miliary TB and six (21.4%) were cerebral TB. 27 (96.4%) were cured and one (3.6%) died. 15 neonates were identified, nine of which were healthy. Two were small for the gestational age (SGA) and one was a stillbirth. Three had neonatal TB, one of which died. Nine were legal abortions and four were spontaneous abortions. Indeed, there was a substantial delay in the diagnosis of TB in the pregnant women and a high incidence of both miliary and cerebral TB was evident. With timely treatment, prognosis is positive.
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Affiliation(s)
- Qiang Li
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yanhua Song
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Hongmei Chen
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Li Xie
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Mengqiu Gao
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
| | - Liping Ma
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
| | - Yinxia Huang
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China. .,Department of Infectious Diseases, Capital Medical University, Beijing, China.
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10
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Abstract
Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases.
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Affiliation(s)
- Jai Bhagwan Sharma
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Eshani Sharma
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi, India
| | - Sona Dharmendra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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11
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Wolf B, Krasselt M, de Fallois J, von Braun A, Stepan H. Tuberculosis in Pregnancy - a Summary. Geburtshilfe Frauenheilkd 2019; 79:358-365. [PMID: 31000880 PMCID: PMC6461468 DOI: 10.1055/a-0774-7924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 01/21/2023] Open
Abstract
In recent years, the incidence of tuberculosis in pregnancy in the industrialised countries has increased. Tuberculosis in pregnancy is associated with an increased risk for the mother and child. Even if no figures are available for Germany, an increase in the number of tuberculosis cases among pregnant women can be assumed due to the migratory flows; current data from the USA, for example, also show an increasing incidence of tuberculosis in pregnant women in recent years. The physiological and immunological changes that occur during pregnancy are likely to have a negative impact on the course of the disease and may make it more difficult to confirm the diagnosis. There are no internationally standardised recommendations for diagnosing latent tuberculosis infections. When screening for TB is performed in specific risk populations, an Interferon-γ Release Assay (IGRA) should preferably be carried out according to the current study data. If corresponding symptoms are present and an IGRA test is positive, further diagnostics are indicated, also in pregnancy. If tuberculosis is confirmed, the fact that a woman is pregnant must not delay the initiation of anti-tuberculosis therapy, as an early start of therapy is associated with a more favourable outcome for both mother and child. The common first-line therapeutic drugs may also be used during pregnancy and are considered safe. The treatment of latent tuberculosis during pregnancy is disputed.
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Affiliation(s)
- Benjamin Wolf
- Abteilung für Geburtsmedizin, Universitätsfrauenklinik Leipzig, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Marco Krasselt
- Sektion Rheumatologie, Klinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Jonathan de Fallois
- Interdisziplinäre Internistische Intensiveinheit, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Amrei von Braun
- Fachbereich Infektions- und Tropenmedizin, Klinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Holger Stepan
- Abteilung für Geburtsmedizin, Universitätsfrauenklinik Leipzig, Universitätsklinikum Leipzig AöR, Leipzig, Germany
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Cranmer LM, Langat A, Ronen K, McGrath CJ, LaCourse S, Pintye J, Odeny B, Singa B, Katana A, Nganga L, Kinuthia J, John-Stewart G. Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs. Int J Tuberc Lung Dis 2018; 21:256-262. [PMID: 28225335 DOI: 10.5588/ijtld.16.0478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) screening in Prevention of Mother-To-Child Transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. METHODS As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high human immunodeficiency virus (HIV) prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers, and associations with infant cofactors were determined. RESULTS Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (P = 0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (P = 0.02) and non-specific TB symptoms, including cough (P = 0.003), fever (P = 0.05), and difficulty breathing (P = 0.01). TB exposure was reported by 11% of the women, and 15% of the TB-exposed women received isoniazid preventive therapy. CONCLUSIONS Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.
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Affiliation(s)
- L M Cranmer
- Emory University School of Medicine and Children's Hospital of Atlanta, Atlanta, Georgia, USA
| | - A Langat
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - K Ronen
- University of Washington, Seattle, Washington
| | - C J McGrath
- University of Texas Medical Branch, Galveston, Texas, USA
| | - S LaCourse
- University of Washington, Seattle, Washington
| | - J Pintye
- University of Washington, Seattle, Washington
| | - B Odeny
- University of Washington, Seattle, Washington
| | - B Singa
- Kenya Medical Research Institute, Nairobi
| | - A Katana
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - L Nganga
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - J Kinuthia
- Kenyatta National Hospital, Nairobi, Kenya
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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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Bhanothu V, Lakshmi V, Theophilus JP, Rozati R, Badhini P, Vijayalaxmi B. Investigation of Toll-Like Receptor-2 (2258G/A) and Interferon Gamma (+874T/A) Gene Polymorphisms among Infertile Women with Female Genital Tuberculosis. PLoS One 2015; 10:e0130273. [PMID: 26114934 PMCID: PMC4483232 DOI: 10.1371/journal.pone.0130273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 05/19/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Toll-like receptor 2 (TLR2) and interferon-gamma (IFN-γ) coordinate with a diverse array of cellular programs through the transcriptional regulation of immunologically relevant genes and play an important role in immune system, reproductive physiology and basic pathology. Alterations in the functions of TLR2 2258G (guanine)/ A, IFN-γ (+874T/A) and signalling molecules that result from polymorphisms are often associated with susceptibility or resistance, which may, in turn, establish the innate host response to various infectious diseases. Presently, we proposed to investigate the risk of common single nucleotide polymorphism (SNP) of TLR2 and IFN-γ genes, for their effect on infertility in women with female genital tuberculosis (FGTB) and healthy women as controls. METHODOLOGY/PRINCIPAL FINDINGS Genotyping of TLR2 and IFN-γ gene polymorphisms was performed by amplification refractory mutation system multi-gene/multi-primer polymerase chain reaction followed by restriction fragment length polymorphism in 175 FGTB patients and 100 healthy control women (HCW). The TLR2 polymorphism [adenine (A) allele] was observed in 57.7 and 58.0% of FGTB patients and HCW, respectively. The IFN-γ (+874T/A) polymorphism (A allele) was significant in 74.3 and 71.0% of FGTB patients and HCW, respectively, while the odds ratios for the AA and TA genotypes for predisposition of FGTB were found to be 0.304 and 1.650 in HCW, respectively. The SNP of TLR2 was not associated with FGTB but the SNP of IFN-γ was found to be associated with mycobacteria infections and to induce infertility. CONCLUSIONS/SIGNIFICANCE At present, we hypothesize that infertile women with FGTB and HCW without tuberculosis (TB) have identical frequency of TLR variants, which may be adequate in the production of IFN-γ in response to Mycobacterium tuberculosis infections. Thus, the study appears to be the first of its kind reporting a mutation in the IFN-γ gene [+874 T (thymine) to A] responsible for susceptibility to TB infections and further inducing infertility.
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Affiliation(s)
- Venkanna Bhanothu
- Department of Zoology, University College of Science, Osmania University, Hyderabad, Telangana State, India
| | - Vemu Lakshmi
- Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana State, India
| | - Jane P. Theophilus
- Department of Zoology, University College of Science, Osmania University, Hyderabad, Telangana State, India
| | - Roya Rozati
- Department of Obstetrics and Gynecology, Owaisi Hospital & Research Centre, Hyderabad, Telangana State, India
| | - Prabhakar Badhini
- Department of Genetics, University College of Science, Osmania University, Hyderabad, Telangana State, India
| | - Boda Vijayalaxmi
- Department of Obstetrics and Gynecology, Owaisi Hospital & Research Centre, Hyderabad, Telangana State, India
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Nguyen HT, Pandolfini C, Chiodini P, Bonati M. Tuberculosis care for pregnant women: a systematic review. BMC Infect Dis 2014; 14:617. [PMID: 25407883 PMCID: PMC4241224 DOI: 10.1186/s12879-014-0617-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/06/2014] [Indexed: 12/01/2022] Open
Abstract
Background Tuberculosis (TB) during pregnancy may lead to severe consequences affecting both mother and child. Prenatal care could be a very good opportunity for TB care, especially for women who have limited access to health services. The aim of this review was to gather and evaluate studies on TB care for pregnant women. Methods We used a combination of the terms “tuberculosis” and “pregnancy”, limited to human, to search for published articles. Studies reflecting original data and focusing on TB care for pregnant women were included. All references retrieved were collected using the Reference Manager software (Version 11). Results Thirty five studies were selected for review and their data showed that diagnosis was often delayed because TB symptoms during pregnancy were not typical. TB prophylaxis and anti-TB therapy appeared to be safe and effective for pregnant women and their babies when suitable follow up and early initiation were present, but the compliance rate to TB prophylaxis is still low due to lack of follow up and referral services. TB care practices in the reviewed studies were in line in principle with the WHO International Standards for Tuberculosis Care (ISTC). Conclusions Integration of TB care within prenatal care would improve TB diagnosis and treatment for pregnant women. To improve the quality of TB care, it is necessary to develop national level guidelines based on the ISTC with detailed guidelines for pregnant women. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0617-x) contains supplementary material, which is available to authorized users.
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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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Inda L, Pérez M, Taicz M, Casimir L, Bologna R. Tuberculosis congénita. An Pediatr (Barc) 2013; 79:198-200. [DOI: 10.1016/j.anpedi.2013.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 10/27/2022] Open
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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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Asuquo B, Vellore AD, Walters G, Manney S, Mignini L, Kunst H. A case–control study of the risk of adverse perinatal outcomes due to tuberculosis during pregnancy. J OBSTET GYNAECOL 2012; 32:635-8. [DOI: 10.3109/01443615.2012.704436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jana N, Barik S, Arora N, Singh AK. Tuberculosis in pregnancy: the challenges for South Asian countries. J Obstet Gynaecol Res 2012; 38:1125-36. [PMID: 22563776 DOI: 10.1111/j.1447-0756.2012.01856.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Despite tuberculosis (TB) being a global problem, maternal TB remains an unrecognized and underestimated tragedy, especially in South Asian countries. Therefore, we performed a non-systematic review regarding implications of maternal TB on obstetric and perinatal outcomes in the South Asian context. MATERIAL AND METHODS We reviewed original studies, both descriptive and analytical, that originated from South Asian countries following an electronic search supplemented by a manual search. Although relevant studies from developed countries were reviewed, they were not included in the tabulation process because those studies had different socioeconomic/epidemiological background. RESULTS Diagnosis of TB is often delayed during pregnancy, because of its non-specific symptoms, and overlapping presentation with other infectious diseases. Poverty, undernutrition, lack of social support and poor health infrastructure along with complications of TB and need for prolonged medications lead to increased maternal morbidity and mortality. Maternal TB in general (except lymphadenitis), is associated with an increased risk of small-for-gestational age, preterm and low-birthweight neonates, and high perinatal mortality. These adverse perinatal outcomes are even more pronounced in women with advanced disease, late diagnosis, and incomplete or irregular drug treatment. There could be a synergy of TB, socioeconomic and nutritional factors, which might have contributed to adverse perinatal effects, especially in low-income countries. CONCLUSIONS As active TB poses grave maternal and perinatal risks, early, appropriate and adequate anti-TB treatment is a mainstay for successful pregnancy outcome. The current knowledge gaps in perinatal implications of maternal TB can be addressed by a multicenter comparative cohort study.
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MESH Headings
- Antitubercular Agents/therapeutic use
- Asia, Western/epidemiology
- Female
- HIV Infections/complications
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/therapy
- Lactation
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/therapy
- Socioeconomic Factors
- Tuberculosis/diagnosis
- Tuberculosis/epidemiology
- Tuberculosis/therapy
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Affiliation(s)
- Narayan Jana
- Department of Obstetrics and Gynaecology, Burdwan Medical College, Burdwan, India.
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Zenner D, Kruijshaar ME, Andrews N, Abubakar I. Risk of tuberculosis in pregnancy: a national, primary care-based cohort and self-controlled case series study. Am J Respir Crit Care Med 2011; 185:779-84. [PMID: 22161161 DOI: 10.1164/rccm.201106-1083oc] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) disease adversely affects mother and child, and strategies to control TB in this group are important. The aim of this study was to analyze the epidemiology of TB in pregnancy, and to establish whether pregnancy is an independent risk factor for TB. METHODS The United Kingdom-wide cohort study was based on the General Practitioner Research Database (GPRD), enrolling all women with pregnancies between 1996 and 2008. Incidence rates and incidence rate ratios (IRRs) of TB events during pregnancy, 6 months postpartum, and outside pregnancy were calculated and compared by Poisson regression. A nested self-controlled case series compared the risk of TB in these periods, adjusting for individual and time-bound confounders. MEASUREMENTS AND MAIN RESULTS The crude TB rate for the combined pregnancy and postpartum period was 15.4 per 100,000 person-years, significantly higher than outside of pregnancy (9.1 per 100,000 person-years; P = 0.02). Adjusting for age, region, and socioeconomic status the postpartum TB risk was significantly higher than outside pregnancy (IRR, 1.95; 95% confidence interval [CI], 1.24-3.07), whereas there was no significant increase during pregnancy (IRR, 1.29; 95% CI, 0.82-2.03). These observations were confirmed in the self-controlled case series (IRR, 1.62; 95% CI, 1.01-2.58 and IRR, 1.03; 95% CI, 0.64-1.65, respectively). CONCLUSIONS The incidence of TB diagnosis is significantly increased postpartum. Although we did not find an increase during pregnancy, the postpartum incidence may reflect an increase during pregnancy given diagnostic, immunological and administrative delays. Clinicians' awareness should be improved and the effectiveness of public health policy measures such as targeted screening of pregnant and postpartum women in high-risk groups should be evaluated.
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Affiliation(s)
- Dominik Zenner
- Health Protection Agency, Health Protection Services Colindale, London, UK.
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Active tuberculosis case-finding among pregnant women presenting to antenatal clinics in Soweto, South Africa. J Acquir Immune Defic Syndr 2011; 57:e77-84. [PMID: 21436710 DOI: 10.1097/qai.0b013e31821ac9c1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) and tuberculosis (TB) are among the leading causes of death among women of reproductive age worldwide. TB is a significant cause of maternal morbidity. Detection of TB during pregnancy could provide substantial benefits to women and their children. METHODS This was a cross-sectional implementation research study of integrating active TB case-finding into existing antenatal and prevention of mother-to-child transmission services in six clinics in Soweto, South Africa. All pregnant women 18 years of age or older presenting for routine care to these public clinics were screened for symptoms of active TB, cough for 2 weeks or longer, sputum production, fevers, night sweats, or weight loss, regardless of their HIV status. Participants with any symptom of active TB were asked to provide a sputum specimen for smear microscopy, mycobacterial culture and drug-susceptibility testing. RESULTS Between December 2008 and July 2009, 3963 pregnant women were enrolled and screened for TB, of whom 1454 (36.7%) were HIV-seropositive. Any symptom of TB was reported by 23.1% of HIV-seropositive and 13.8% of HIV-seronegative women (P < 0.01). Active pulmonary TB was diagnosed in 10 of 1454 HIV-seropositve women (688 per 100,000) and 5 of 2483 HIV-seronegative women (201 per 100,000, P = 0.03). The median CD4⁺ T-cell count among HIV-seropositive women with TB was similar to that of HIV-seropositive women without TB (352 versus 333 cells/μL, P = 0.85). CONCLUSIONS There is a high burden of active TB among HIV-seropositive pregnant women. TB screening and provision of isoniazid preventive therapy and antiretroviral therapy should be integrated with prevention of mother-to-child transmission services.
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Knight M, Kurinczuk JJ, Nelson-Piercy C, Spark P, Brocklehurst P. Tuberculosis in pregnancy in the UK
Authors’ Reply. BJOG 2009. [DOI: 10.1111/j.1471-0528.2009.02270.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Tuberculosis (TB) is a globally important cause of morbidity and mortality with an increasing incidence in women of reproductive ages. This descriptive study using the UK Obstetric Surveillance System demonstrates key differences in the presentation of TB during pregnancy compared with the nonpregnant population. The disease is limited to ethnic minority women, most commonly recent immigrants. Presentation may be atypical, with extrapulmonary disease as common as pulmonary. Clinicians should be aware of the potential for nonspecific presentation of the disease in pregnancy and consider the diagnosis in women, especially recently arrived immigrants, presenting with nonspecific symptoms.
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Affiliation(s)
- M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
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González Martínez F, Navarro Gómez ML, Santos Sebastián MM, Saavedra Lozano J, Hernández Sampelayo T. [Tuberculosis during pregnancy and congenital tuberculosis]. An Pediatr (Barc) 2009; 70:512-4. [PMID: 19380261 DOI: 10.1016/j.anpedi.2009.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 01/29/2009] [Accepted: 02/19/2009] [Indexed: 01/07/2023] Open
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Raouf S, Sharma S, Sunanda GV, Jafettasj J, Papaioannou S. Disseminated extra pulmonary tuberculosis in an immune competent pregnant woman. J OBSTET GYNAECOL 2009; 29:148-50. [PMID: 19274554 DOI: 10.1080/01443610802643741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S Raouf
- Department of Obstetrics and Gynecology, Heart of England NHS Foundation Trust, Birmingham, UK.
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Keskin N, Yilmaz S. Pregnancy and tuberculosis: to assess tuberculosis cases in pregnancy in a developing region retrospectively and two case reports. Arch Gynecol Obstet 2008; 278:451-5. [DOI: 10.1007/s00404-008-0594-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
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Multiple Choice Questions. Obstet Med 2007. [DOI: 10.1007/978-1-84628-582-0_1] [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] Open
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Abstract
PURPOSE OF REVIEW To provide a summary of the diagnostic and therapeutic challenges, including risks and benefits of treatment, of tuberculosis and latent Mycobacterium tuberculosis infection during pregnancy. RECENT FINDINGS Recent developments in diagnostic options have added to the armamentarium of tests available to diagnose latent Mycobacterium tuberculosis infection. Increasing evidence supports the potential for successful treatment of multidrug-resistant tuberculosis during pregnancy with good maternal and neonatal outcomes. The impact of genital tuberculosis on the outcome of assisted in-vitro fertilization techniques is noted. SUMMARY The diagnostic approach for the evaluation of tuberculosis or latent Mycobacterium tuberculosis infection is unchanged by pregnancy, and includes clinical suspicion of disease, tuberculin skin testing or interferon-gamma-based assay, chest radiography with appropriate shielding when indicated, and acid-fast bacillus stain and culture of clinical material. For patients with active tuberculosis, therapy should be initiated as soon as the diagnosis is established. Initiation of treatment for latent infection during pregnancy should be considered based on the risk for progression to active disease.
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Affiliation(s)
- Linda S Efferen
- Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York 11042, USA.
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Stone S, Nelson-Piercy C. Respiratory disease in pregnancy. OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 2007; 17:140-146. [PMID: 32288782 PMCID: PMC7104998 DOI: 10.1016/j.ogrm.2007.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breathlessness in the absence of an underlying pathology is common in pregnancy. Asthma affects about 7% of women of childbearing age. Treatment is the same as for the non-pregnant population and most drugs are safe in pregnancy. Educating women to continue preventer inhaled corticosteroid therapy will reduce the risk of attacks. Respiratory infections are associated with a higher morbidity in pregnancy and should be treated aggressively. Most chronic pulmonary diseases do not alter fertility. Large reserves in respiratory function allow the fetus and mother to survive without compromise in most cases. The use of chest X-rays should not be avoided in pregnancy. Women with a chronic respiratory disease should receive pre-pregnancy counselling and education. Women should be managed in a multidisciplinary setting with the respiratory team. The presence of pulmonary hypertension and cor pulmonale is associated with a high risk of death in pregnancy.
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Kutlu T, Tugrul S, Aydin A, Oral O. Tuberculous meningitis in pregnancy presenting as hyperemesis gravidarum. J Matern Fetal Neonatal Med 2007; 20:357-9. [PMID: 17437245 DOI: 10.1080/14767050601178766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tayfun Kutlu
- Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
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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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