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Tuberculosis Infection in Pregnant People: Current Practices and Research Priorities. Pathogens 2022; 11:pathogens11121481. [PMID: 36558815 PMCID: PMC9782762 DOI: 10.3390/pathogens11121481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Women are significantly more likely to develop tuberculosis (TB) disease within the first 90 days after pregnancy than any other time in their lives. Whether pregnancy increases risk of progression from TB infection (TBI) to TB disease is unknown and is an active area of investigation. In this review, we discuss the epidemiology of TB and TBI in pregnancy, TBI diagnostics, and prevalence in pregnancy. We also review TBI treatment and highlight research priorities, such as short-course TB prevention regimens, drug-resistant TB prevention, and additional considerations for safety, tolerability, and pharmacokinetics that are unique to pregnant and postpartum people.
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Chalid MT, Puspawaty D, Tahir AM, Najdah H, Massi MN. Tuberculin test versus interferon gamma release assay in pregnant women with household contacts of tuberculosis patients. Int J Mycobacteriol 2022; 11:364-370. [PMID: 36510919 DOI: 10.4103/ijmy.ijmy_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Pregnant women who live in tuberculosis (TB)-affected households are more likely to develop latent TB infection (LTBI), which often escapes treatment. This study aims to determine if Interferon-gamma release (IGRA) is reliable in screening for LTBI in pregnant women, compare to the tuberculin skin test (TST). Methods It was a cross-sectional study that involved 60 pregnant women with TB contact history as a proxy for LTBI and 30 pregnant women without contact history. Latent TB was detected using the TST 5 tuberculin units and IGRA using the QuantiFERON Gold Plus TB Test kit (QFT-Plus). The sensitivity and specificity of the two diagnostic methods and the agreement between them were estimated using SPSS version 20.0. Results The sensitivity 95% (95% confidence interval [CI]: 86.08%-98.96%) and specificity 26.7% (95% CI: 12.28%-45.89%) of TST were compared to that of the IGRA with 60% (95% CI: 46.54%-72.44%) and 73.3% (95% CI: 54.11%-87.72%) sensitivity and specificity, respectively in detecting LTBI in pregnancy. Although there was a significant difference (P < 0.05) between TST and IGRA, the agreement was fair (kappa 0.39; 95% CI: 0.24-0.45). Conclusion TST assay is more sensitive than IGRA; however, the specificity of IGRA was superior to the TST method. In this study, a fair agreement of TST and IGRA was observed for detecting latent TB infection in pregnant women with household contact with TB patients.
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Affiliation(s)
- Maisuri Tadjuddin Chalid
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University Hospital, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Dian Puspawaty
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University Hospital, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Andi Mardiah Tahir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University Hospital, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Hidayah Najdah
- Postgraduate Program, Faculty of Medicine, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Muhammad Nasrum Massi
- Department of Clinical Microbiology, Faculty of Medicine, Hasanuddin University Hospital, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
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Bhosale R, Alexander M, Deshpande P, Kulkarni V, Gupte N, Gupta A, Mathad J. Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India. Int J Infect Dis 2021; 112:205-211. [PMID: 34517050 PMCID: PMC8715310 DOI: 10.1016/j.ijid.2021.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Accurate tuberculosis infection (TBI) tests are critical for pregnant women, especially those with HIV, who have a high risk of TB disease. METHODS We enrolled interferon gamma release assay (IGRA)+ pregnant women with and without HIV in a longitudinal study, followed up at delivery and 6 months postpartum. Tuberculin skin test (TST) and IGRA were compared by HIV status at each timepoint. RESULTS Of 165 enrolled IGRA+ pregnant women: 35 (21%) had HIV and were on antiretroviral therapy with median CD4 of 476 (IQR 399-586). Compared to antepartum, significantly fewer women remained IGRA+ at delivery [HIV+ n=21/35 (62%, p=0.009); HIV- n=100/130 (77%, p=0.002)] and postpartum [HIV+ n=30/35 (87%, p=0.03); HIV- n=116/130 (89%, p=0.01)]. IGRA/TST discordance was high in pregnant women (HIV+: 51%; HIV-: 25%). Median IFN-γ was lowest for all women at delivery; significantly lower in women with HIV at all timepoints compared to women without HIV. TB incidence was 50/ 1000 person-years and 18/1000 person-years among women with and without HIV respectively. CONCLUSIONS Pregnancy affects TBI test results and reduces IFN-γ response to M. tuberculosis stimulation. Despite adequate CD4 counts, women with HIV express less IFN-γ than women without HIV, which may explain the high TB incidence in postpartum women with HIV.
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Affiliation(s)
- Ramesh Bhosale
- Byramjee Jeejeebhoy Government Medical College, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India
| | - Mallika Alexander
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India.
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India; Johns Hopkins School of Medicine, 600 N. Wolfe Street, Phipps 540, Baltimore, MD 1287, USA
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India; Johns Hopkins School of Medicine, 600 N. Wolfe Street, Phipps 540, Baltimore, MD 1287, USA
| | - Jyoti Mathad
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Trials Unit, 1st Floor, ENT department, Jai Prakash Narayan Rd. Pune, 411001, Maharashtra, India; Weill Cornell Medical College, 402 E. 67th Street, 2nd floor, New York, NY 10065, USA
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Birku M, Desalegn G, Kassa G, Tsegaye A, Abebe M. Effect of pregnancy and HIV infection on detection of latent TB infection by Tuberculin Skin Test and QuantiFERON-TB Gold In-Tube assay among women living in a high TB and HIV burden setting. Int J Infect Dis 2020; 101:235-242. [PMID: 33039610 DOI: 10.1016/j.ijid.2020.09.1452] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the effect of pregnancy and Human immunodeficiency virus (HIV) infection on detection performances of tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFTGIT) for the diagnosis of latent tuberculosis infection (LTBI) among women living in high TB and HIV endemic setting. METHOD A cross-sectional study was conducted among women with and without pregnancy and HIV infection. Three-hundred twenty women were enrolled in this study and were diagnosed using TST and QFTGIT for the detection of LTBI. RESULTS Overall prevalence of LTBI among the enrolled women was 55.6%, 46.3% and 51.1% as determined by TST, QFTGIT and concordant TST/QFTGIT results, respectively. Our study revealed that pregnancy or HIV infection reduced the rate of detection of LTBI by TST and QFTGIT tests, with the utmost effect observed in HIV-positive pregnant women. Additionally, we observed that the concordance between TST and QFTGIT among women increased with the presence of pregnancy and/or HIV infection. A history of contact with TB patients was significantly associated with positivity of TST and QFTGIT. CONCLUSION This study demonstrated that both pregnancy and HIV infection profoundly affected the detection performance of TST and QFTGIT, which may be associated with immunosuppression of anti-mycobacterial immunity in women with pregnancy and/or HIV infection.
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Affiliation(s)
- Mahlet Birku
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia; Department of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Desalegn
- Department of Medical Microbiology and Immunology, Mekelle University, Mekelle, Ethiopia.
| | - Getachew Kassa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Markos Abebe
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
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Effect of Pregnancy on Interferon Gamma Release Assay and Tuberculin Skin Test Detection of Latent TB Infection Among HIV-Infected Women in a High Burden Setting. J Acquir Immune Defic Syndr 2017; 75:128-136. [PMID: 28141782 DOI: 10.1097/qai.0000000000001298] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peripartum immunologic changes may affect latent tuberculosis infection (LTBI) diagnostic performance among HIV-infected women. METHODS HIV-infected women were serially tested with tuberculin skin test (TST) and interferon gamma release assay [QuantiFERON TB Gold In-tube (QFT)] in pregnancy and 6 weeks postpartum in Kenya. Prevalence, sensitivity and agreement, and correlates of QFT/TST positivity were assessed. Quantitative QFT mitogen and Mycobacterium tuberculosis antigen (Mtb-Ag) responses were compared by peripartum stage. Incidence of test conversion at 6 weeks postpartum was evaluated in baseline TST-/QFT- women. RESULTS Among 100 HIV-infected women, median age was 26 years, median CD4 was 555 cells per cubic millimeter, and 88% were on antiretrovirals. More women were QFT+ than TST+ in both pregnancy (35.4% vs. 13.5%, P = 0.001) and postpartum (29.6% vs. 14.8%, P < 0.001). Among 18 consistently QFT+ women, 8 (44%) converted from TST- to TST+, with improved test agreement postpartum (56.9%, κ = 0.20 to 82.4%, κ = 0.60). Three initially QFT-/TST- women had test conversion (TST+ and/or QFT+), suggesting new infection (incidence 13.4/100 person-years). Mean QFT mitogen (4.46 vs. 7.64 IU/mL, P < 0.001) and Mtb-Ag (1.03 vs. 1.54 IU/mL, P = 0.03) responses were lower among all women retested in pregnancy vs. postpartum, and specifically among persistently QFT+ women (Mtb-Ag: 3.46 vs. 4.48 IU/mL, P = 0.007). QFT indeterminate rate was higher in pregnancy (16%) compared with postpartum (0%) because of lower mitogen response. CONCLUSIONS QFT identified >2-fold more women with LTBI compared with TST in pregnancy and postpartum. Lower QFT Mtb-Ag and mitogen responses in pregnancy compared with postpartum suggest that pregnancy-associated immunologic changes may influence LTBI test performance.
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Mathad JS, Bhosale R, Balasubramanian U, Kanade S, Mave V, Suryavanshi N, Gupte N, Joshi S, Chandanwale A, Dupnik KM, Kulkarni V, Deshpande P, Fitzgerald DW, Gupta A. Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women. Am J Respir Crit Care Med 2017; 193:1421-8. [PMID: 26765255 DOI: 10.1164/rccm.201508-1595oc] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Pregnant women with latent tuberculosis infection (LTBI) are at high risk for development of TB, especially if infected with HIV. OBJECTIVES To assess the performance of LTBI tests in pregnant and postpartum women infected with HIV, investigate the immunology behind discordance in pregnancy, and explore the implications for the development of postpartum TB. METHODS We screened pregnant women in their second/third trimester and at delivery for LTBI using the tuberculin skin test (TST) and IFN-γ release assay (IGRA) (QuantiFERON Gold). A subset of antepartum women had longitudinal testing, with repeat testing at delivery and postpartum and additional cytokines measured from the IGRA supernatant. The kappa statistic and Wilcoxon rank sum test were used to determine agreement and comparison of cytokine concentrations, respectively. MEASUREMENTS AND MAIN RESULTS Of 252 enrolled, 71 (28%) women had a positive IGRA but only 27 (10%) had a positive TST (P < 0.005). There was 75% agreement (kappa, 0.25). When stratified by pregnancy versus delivery, 20% had IGRA(+)/TST(-) discordance at each time point. A positive IGRA was associated with known TB contact (odds ratio, 3.6; confidence interval, 1.2-11.1; P = 0.02). Compared with IGRA(+)/TST(+), women with IGRA(+)/TST(-) discordance had significantly less IFN-γ (1.85 vs. 3.48 IU/ml; P = 0.02) and IL-2 (46.17 vs. 84.03 pg/ml; P = 0.01). Five developed postpartum TB, of which three had IGRA(+)/TST(-) discordance during pregnancy. CONCLUSIONS Choice of LTBI test in pregnant women infected with HIV affects results. Pregnant women with IGRA(+)/TST(-) discordance had less IFN-γ and IL-2 than those with concordant-positive results and may represent an especially high-risk subset for the development of active TB postpartum.
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Affiliation(s)
- Jyoti S Mathad
- 1 Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
| | - Ramesh Bhosale
- 2 Department of Obstetrics and Gynaecology, Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune, India
| | - Usha Balasubramanian
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
| | - Savita Kanade
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
| | - Vidya Mave
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India.,4 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Nishi Suryavanshi
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
| | - Nikhil Gupte
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India.,4 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Samir Joshi
- 5 Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune, India
| | - Ajay Chandanwale
- 5 Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospital, Pune, India
| | - Kathryn M Dupnik
- 1 Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
| | - Vandana Kulkarni
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
| | - Prasad Deshpande
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India
| | - Daniel W Fitzgerald
- 1 Center for Global Health, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
| | - Amita Gupta
- 3 Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, India.,4 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Malhamé I, Cormier M, Sugarman J, Schwartzman K. Latent Tuberculosis in Pregnancy: A Systematic Review. PLoS One 2016; 11:e0154825. [PMID: 27149116 PMCID: PMC4858222 DOI: 10.1371/journal.pone.0154825] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In countries with low tuberculosis (TB) incidence, immigrants from higher incidence countries represent the major pool of individuals with latent TB infection (LTBI). The antenatal period represents an opportunity for immigrant women to access the medical system, and hence for potential screening and treatment of LTBI. However, such screening and treatment during pregnancy remains controversial. OBJECTIVES In order to further understand the prevalence, natural history, screening and management of LTBI in pregnancy, we conducted a systematic literature review addressing the screening and treatment of LTBI, in pregnant women without known HIV infection. METHODS A systematic review of 4 databases (Embase, Embase Classic, Medline, Cochrane Library) covering articles published from January 1st 1980 to April 30th 2014. Articles in English, French or Spanish with relevant information on prevalence, natural history, screening tools, screening strategies and treatment of LTBI during pregnancy were eligible for inclusion. Articles were excluded if (1) Full text was not available (2) they were case series or case studies (3) they focused exclusively on prevalence, diagnosis and treatment of active TB (4) the study population was exclusively HIV-infected. RESULTS Of 4,193 titles initially identified, 208 abstracts were eligible for review. Of these, 30 articles qualified for full text review and 22 were retained: 3 cohort studies, 2 case-control studies, and 17 cross-sectional studies. In the USA, the estimated prevalence of LTBI ranged from 14 to 48% in women tested, and tuberculin skin test (TST) positivity was associated with ethnicity. One study suggested that incidence of active TB was significantly increased during the 180 days postpartum (Incidence rate ratio, 1.95 (95% CI 1.24-3.07). There was a high level of adherence with both skin testing (between 90-100%) and chest radiography (93-100%.). In three studies from low incidence settings, concordance between TST and an interferon-gamma release assay was 77, 88 and 91% with kappa values ranging from 0.26 to 0.45. In low incidence settings, an IGRA may be more specific and less sensitive than TST, and results do not appear to be altered by pregnancy. The proportion of women who attended follow-up visits after positive tuberculin tests varied from 14 to 69%, while 5 to 42% of those who attended follow-up visits completed a minimum of 6 months of isoniazid treatment. One study raised the possibility of an association of pregnancy/post-partum state with INH hepatitis (risk ratio 2,5, 95% CI 0.8-8.2) and fatal hepatotoxicity (rate ratio 4.0, 95% CI 0.2-258). One study deemed INH safe during breastfeeding based on peak concentrations in plasma and breast milk after INH administration. CONCLUSION Pregnancy is an opportunity to screen for LTBI. Interferon-gamma release assays are likely comparable to tuberculin skin tests and may be used during pregnancy. Efforts should be made to improve adherence with follow-up and treatment post-partum. Further data are needed with respect to safety and feasibility of antepartum INH therapy, and with respect to alternative treatment regimens.
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Affiliation(s)
- Isabelle Malhamé
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, Montreal, Quebec, Canada
| | - Maxime Cormier
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, Montreal, Quebec, Canada
| | - Jordan Sugarman
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, Montreal, Quebec, Canada
| | - Kevin Schwartzman
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, Montreal, Quebec, Canada
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Chen Q, Guo X, Wang X, Wang M. T-SPOT.TB in Detection of Active Tuberculosis During Pregnancy: A Retrospective Study in China. Med Sci Monit 2016; 22:57-60. [PMID: 26732770 PMCID: PMC4708096 DOI: 10.12659/msm.896943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Interferon-gamma release assays have not been validated in active TB among pregnant women. Therefore, the objective of this retrospective study was to estimate the diagnostic value of T-SPOT.TB in active TB among pregnant women. MATERIAL/METHODS Between May 2012 and May 2015, 26 consecutive pregnant women with suspected TB were enrolled in our study. The clinicopathological characteristics and T-SPOT.TB results were reviewed and analyzed. RESULTS Pregnant patients were divided into a TB group (n=21) and a Non-TB group (n=5). In the TB group, 5 patients had pulmonary TB, 5 had pulmonary TB+ extrapulmonary TB, and 11 had exclusively extrapulmonary TB. The most common site of extrapulmonary TB was pleural (n=11). Statistical analysis showed that the lymphocyte count in the TB group was lower than in the Non-TB group (P<0.05). For detection of active TB during pregnancy, T-SPOT.TB had a high sensitivity of 100.0% (84.5%-100.0%) and a specificity of 80.0% (37.6-96.4%). CONCLUSIONS T-SPOT.TB shows good performance in detection of active tuberculosis during pregnancy. Interferon gamma release assay for TB screening of pregnant women is recommended in clinical practice because it may be a more appropriate diagnostic tool than the tuberculin skin test.
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Affiliation(s)
- Qiaopei Chen
- Department of Clinical Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi, P.R. China
| | - Xuxiao Guo
- Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Xinfeng Wang
- Department of Laboratory Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong,, P.R. China
| | - Maoshui Wang
- Department of Laboratory Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong,, P.R. China
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Comparing an Interferon Gamma Release Assay with the Tuberculin Skin Test During Pregnancy: Implications for Tuberculosis Screening During Prenatal Care. Matern Child Health J 2015; 20:1314-20. [DOI: 10.1007/s10995-015-1896-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Baquero-Artigao F, Mellado Peña M, del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez M. Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (I): Epidemiology and diagnosis. Congenital tuberculosis. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Antepartum surgical management of Pott’s paraplegia along with maintenance of pregnancy during second trimester. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1064-9. [DOI: 10.1007/s00586-015-4045-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 11/24/2022]
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Baquero-Artigao F, Mellado Peña MJ, Del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez ML. [Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (i): Epidemiology and diagnosis. Congenital tuberculosis]. An Pediatr (Barc) 2015; 83:285.e1-8. [PMID: 25754313 DOI: 10.1016/j.anpedi.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 12/18/2022] Open
Abstract
Tuberculosis (TB) screening in pregnancy using tuberculin skin test (TST) is recommended in case of symptoms of TB disease, close contact with a patient with infectious TB, or high risk of developing active disease. The new interferon gamma release assay (IGRA) tests are recommended in BCG-vaccinated pregnant women with positive TST and no known risk factors for TB, and in those immunocompromised, with clinical suspicion of TB but negative TST. TB diagnosis is difficult due to the non-specific symptoms, the increased frequency of extrapulmonary disease, the delay in radiological examinations, and the high rate of tuberculin anergy. Neonatal TB can be acquired in utero (congenital TB), or through airborne transmission after delivery (postnatal TB). Congenital TB is extremely rare and does not cause fetal malformations. It may be evident at birth, although it usually presents after the second week of life. In newborns with no family history of TB, the disease should be considered in cases of miliary pneumonia, hepatosplenomegaly with focal lesions, or lymphocytic meningitis with hypoglycorrhachia, especially in those born to immigrants from high TB-burden countries. TST is usually negative, and IGRAs have lower sensitivity than in older children. However, the yield of acid-fast smear and culture is higher, mostly in congenital TB. Molecular diagnosis techniques enable early diagnosis and detection of drug resistance mutations. There is a substantial risk of disseminated disease and death.
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Affiliation(s)
- F Baquero-Artigao
- Grupo de Infección Congénita y Perinatal de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España.
| | - M J Mellado Peña
- Grupo de Tuberculosis de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España
| | - T Del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España
| | - A Noguera Julián
- Unidad de Infecciones, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - A Goncé Mellgren
- Servicio de Medicina Maternofetal, Institut Clínic de Ginecología, Obstetricia i Neonatologia, Hospital Clínic, Barcelona, España
| | | | - M L Navarro Gómez
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Gregorio Marañón, Madrid, España
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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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Positive Interferon-Gamma Release Assay Leading to a Diagnosis of Mycobacterium tuberculosis Pericarditis in Pregnancy. Obstet Gynecol 2014; 124:475-477. [DOI: 10.1097/aog.0000000000000272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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New Advances in Diagnosis of Latent Tuberculosis Infection: A Review Article. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2014. [DOI: 10.5812/pedinfect.22368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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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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Performance of an Interferon-Gamma Release Assay to Diagnose Latent Tuberculosis Infection During Pregnancy. Obstet Gynecol 2012; 119:1088-95. [DOI: 10.1097/aog.0b013e3182546aff] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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