Tuberculosis In Pregnant Women Research Articles

Midwifery hurdles: Navigating tuberculosis screening challenges in South Africa.

In South Africa, screening for tuberculosis during pregnancy is a serious challenge. Tuberculosis is one of the leading indirect causes of mortality in pregnant women. The objective of the study was to explore the challenges experienced by midwives regarding tuberculosis in pregnant women. A qualitative exploratory research method was used to conduct the study. The study population comprised midwives who worked at primary healthcare clinics in the selected local area, Capricorn District, Limpopo province. Purposive non-probability sampling was used to select 10 participants. Data from participants were acquired using in-depth individual semi-structured interviews. Data analysis was carried out using manual thematic analysis following Tesch's technique. The outcomes of this study included midwives knowing their roles regarding tuberculosis screening among pregnant women. They further highlighted their challenges while screening tuberculosis in pregnant women, such as shortage of screening tools, withholding of tuberculosis information, and language barrier. Midwives should have the necessary equipment and be trained in various languages used in the province to improve tuberculosis screening among all pregnant women.Contribution:Infected pregnant women and their unborn children's health can be improved by tuberculosis screening.

Specific Features of the Course and Treatment of Respiratory Tuberculosis in Women during Pregnancy and Postpartum Period. Perinatal Outcomes

The objective: to study specific features of the respiratory tuberculosis course and effectiveness of its treatment during pregnancy and postpartum period, and to evaluate the impact of tuberculosis on perinatal outcomes.Subjects and Methods. In 2010 - 2022, a retrospective-prospective case-control study enrolling 164 patients of reproductive age was conducted in Central Tuberculosis Research Institute. Two groups were formed: Case Group included 82 pregnant women with respiratory tuberculosis; Control Group included 82 non-pregnant patients with respiratory tuberculosis.Results. In both groups, new cases of respiratory tuberculosis were notified more often versus relapses. Distinctive features of respiratory tuberculosis in pregnant women versus the non-pregnant were as follows: the predominance of the proportion of extensive drug resistant M. tuberculosis – 55.5% versus 31.7% (p<0.05), respectively; lower frequency of lung tissue destruction – 18.3% versus 32.9% (p≤0.05); higher incidence of cavities - 80% and 40.7% (p≤0.05) and complications of respiratory tuberculosis – 25.6% versus 12.2% (p≤0.03), respectively. The high effectiveness of respiratory tuberculosis treatment such as relief of clinical symptoms and sputum conversion was achieved at the end of the intensive therapy phase both in Case Group and Control Group. Longer time until sputum conversion and lower rate of cavity healing were reported in the patients from Case Group. In 75.6% of pregnant women from Case Group there was a delivery with favorable perinatal outcomes.

HIV/Tuberculosis Coinfection in Pregnancy and the Postpartum Period.

The convergence of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) represents a considerable global public health challenge. The concurrent infection of HIV and TB in pregnant women not only intensifies the transmission of HIV from mother to fetus but also engenders adverse outcomes for maternal health, pregnancy, and infant well-being, necessitating the implementation of integrated strategies to effectively address and manage both diseases. In this article, we review the pathophysiology, clinical presentation, treatment, and management of HIV/TB coinfection during pregnancy, the postpartum period, and lactation and highlight the differences compared to the general population.

Tuberculosis and pregnancy: literature review

Aim: To evaluate the modern view on the problem of tu-berculosis (TB) in pregnant women and puerperae. Materi-als and methods. A search was performed in the electron-ic databases PubMed, eLIBRARY.RU and CyberLeninka, the following terms were used: «tuberculosis», «pregnancy», «mycobacterium tuberculosis», «diagnosis», «treatment», «infertility», «postpartum period», «puerperants». 130 ref-erences were found and 50 articles selected. Results. Com-plaints in pregnant women with TB depend on the location of the infectious process, the duration of pregnancy and the time of TB detection. Diagnosis of TB in pregnant wom-en includes chest X-ray, rapid molecular diagnostics, con-ventional culture, and others. Most studies have shown the negative impact of pregnancy on the course and outcome of TB, as well as the occurrence of various complications of pregnancy. Also, women with TB often have various ma-ternal and perinatal adverse outcomes. The postpartum period is most often complicated, and a baby can become infected with TB from the mother transplacentally, trans-amniotically and by airborne droplets at birth. Expressed breast milk is a safe alternative while breastfeeding. Con-clusions. The problem of diagnosing and treating TB in pregnant women is quite relevant at the present time and requires special attention of phthisiatricians and obstetricians- gynecologists, which is due to higher risks of progression of the infectious process and the occurrence of various complications during pregnancy, childbirth, or the postpartum period.

Transcriptional Analysis for Tuberculosis in Pregnant Women From the PRegnancy Associated Changes In Tuberculosis Immunology (PRACHITi) Study.

A new tuberculosis (TB) diagnostic cartridge assay, which detects a 3-gene TB signature in whole blood, was not diagnostic in women with maternal TB disease in India (area under the curve [AUC] = 0.72). In a cohort of pregnant women, we identified a novel gene set for TB diagnosis (AUC = 0.97) and one for TB progression (AUC = 0.96).

Integrating tuberculosis screening into antenatal visits to improve tuberculosis diagnosis and care: Results from a pilot project in Pakistan

BackgroundActive tuberculosis (TB) during pregnancy has an adverse effect on maternal and neonatal outcomes. This study analysed the results of a pilot project integrating TB screening into antenatal care (ANC) visits in a high-TB-burden, low-resource setting. MethodsData were extracted from the TB screening pilot in obstetrician-gynaecologist clinics of six tertiary care facilities in Karachi, Pakistan from April to December 2017. Data from the verbal symptom screening conducted at each ANC visit for all women and the Xpert MTB/RIF testing for all symptomatic women to investigate TB yield were analysed by assessing the numbers screened, presumptive patients and active TB diagnoses among pregnant women and neonates. ResultsSymptom screening was performed on 113,078 pregnant women, 2,965 (2.6%) of whom reported at least one TB symptom. Sputum samples were collected from 2,896 (97.7%) symptomatic women. Of the 27 (0.9%) newly diagnosed bacteriologically positive TB patients, 25 (93%) initiated TB treatment. No case of vertical TB transmission was reported among 26 live births. DiscussionTB screening is feasible and should be implemented during routine ANC visits in high-TB-burden settings. There is a need to explore a multi-faceted approach with inclusion of clinical examination and chest X-rays to diagnose TB in pregnant women.

Plasma Kynurenine-to-Tryptophan Ratio, a Highly Sensitive Blood-Based Diagnostic Tool for Tuberculosis in Pregnant Women Living With Human Immunodeficiency Virus (HIV).

BackgroundFor pregnant women living with human immunodeficiency virus (HIV), concurrent active tuberculosis (TB) disease increases the risk of maternal mortality and poor pregnancy outcomes. Plasma indoleamine 2,3-dioxygenase (IDO) activity measured by kynurenine-to-tryptophan (K/T) ratio has been proposed as a blood-based TB biomarker. We investigated whether plasma K/T ratio could be used to diagnose active TB among pregnant women with HIV.MethodsUsing an enzyme-linked immunosorbent assay (ELISA), we measured K/T ratio in 72 pregnant women with and active TB and compared them to 117 pregnant women with HIB but without TB, matched by age and gestational age.ResultsPlasma K/T ratio was significantly elevated during pregnancy compared to sampling done after pregnancy (P < .0001). Pregnant women who had received isoniazid preventive therapy (IPT) before enrollment had decreased plasma K/T ratio compared to those who had not received IPT (P = .0174). Plasma K/T ratio was elevated in women with active TB at time of diagnosis compared to those without TB (P < .0001). Using a cutoff of 0.100, plasma K/T ratio gave a diagnostic sensitivity of 94% (95% confidence interval [CI]: 82–95), specificity of 90% (95% CI: 80–91), positive predictive value (PPV) 85% and negative predictive value (NPV) 98%. A receiver operating characteristic curve (ROC) gave an area under the curve of 0.95 (95% CI: .92–.97, P < .0001).In conclusion, plasma K/T ratio is a sensitive blood-based diagnostic test for active TB disease in pregnant women living with HIV. Plasma K/T ratio should be further evaluated as an initial TB diagnostic test to determine its impact on patient care.

Plasma indoleamine 2,3-dioxygenase, a highly sensitive blood-based screening tool for active tuberculosis disease in HIV-infected pregnant women

Background: The World Health Organization has identified the need for a non-sputum-based test capable of detecting active tuberculosis (TB) as a key TB control intervention. Indoleamine 2,3-dioxygenase (IDO) is an enzyme, which converts tryptophan to kynurenines. Recently, IDO activity has been proposed as a blood-based TB biomarker. We investigated whether plasma IDO activity, as measured by kynurenine-to-tryptophan ratio, could be used to screen HIV-infected pregnant women for active TB disease. Methods and materials: Using a commercial enzyme-linked immunosorbent assay (ELISA), we measured plasma tryptophan and kynurenine concentration to determine IDO activity in 78 HIV-infected pregnant women with active TB disease. We compared HIV-infected active TB cases to 120 control subjects from the same cohort with no TB, matched by age, and gestational age. Results: Plasma IDO activity was significantly elevated during pregnancy than in non-pregnant state, and increased transiently during labour (P < 0.0001). There was, however, a marked elevation of IDO activity in TB patients at the time of TB diagnosis (enrolment time-point) compared to pregnant women with no-TB (P < 0.0001). Using a previously determined cut-off of 0.080 in non-pregnant subjects, IDO activity showed a sensitivity of 97% (CI 91–99), specificity of 81% (CI 77–84), PPV 66% and NPV of 99% at the time of TB diagnosis. A receiver operating characteristic curve (ROC) gave area under curve of 0.96 (CI 95–98, P value < 0.0001). The optimal cut-off in pregnant women, however, was calculated as 0.10 with sensitivity of 96% (CI 89–99), specificity of 90% (CI 87–92), PPV 73% and NPV 99%. Conclusion: Plasma IDO activity is a sensitive blood-based screening test for TB in pregnant women living HIV. IDO activity can be measured using ELISA. IDO activity should be used to screen pregnant women at risk active TB disease.

Increased risk of hepatotoxicity and temporary drug withdrawal during treatment of active tuberculosis in pregnant women

BackgroundFew studies have focused on the treatment of tuberculosis (TB) during pregnancy. This study aimed to evaluate the risk of adverse events, particularly liver toxicity, in pregnant women during treatment for active TB. MethodsWe conducted a retrospective study on pregnant and age-matched non-pregnant women receiving treatment for active TB at four hospitals in Western Sweden between 1992 and 2017. ResultsA total of 135 women were included, 40 pregnant and 95 non-pregnant. The frequency of severe hepatotoxicity was 40% in pregnant women and 6% among non-pregnant women (p < 0.001) (odds ratio 9.9; 95% confidence interval 3.5–28.0). Temporary drug withdrawal due to elevated transaminase levels was more frequent for pregnant than non-pregnant women (40% vs 9.5%; p < 0.001) (odds ratio 6.4; 95% confidence interval 2.5–16.2). There was one fatal case of hepatotoxicity in a pregnant woman. ConclusionSevere hepatotoxicity was significantly more frequent in pregnant women compared to non-pregnant women. Careful monitoring of liver transaminases while receiving TB treatment during pregnancy is mandatory, as well as ensuring adequate measures with adjustment of drug regimen and temporary drug withdrawals when a rise in liver enzymes is noted.

Latent tuberculosis in pregnant women: a patient perspective.

SETTING: Screening and treatment for latent tuberculosis (LTBI) in pregnant women remains controversial, although studies suggest there is a significantly increased risk of progression to active disease in the postpartum period. Studies have also shown that adherence to postpartum follow-up and treatment of LTBI is poor. To our knowledge, the reasons for this have not been investigated. We therefore identified pregnant women originating from high-burden tuberculosis (TB) countries now living in the Stockholm region, and screened and treated them for LTBI.OBJECTIVE: To explore how women diagnosed with LTBI during pregnancy understood and experienced their diagnosis and treatment.DESIGN: Sixteen semi-structured interviews with women on treatment for LTBI were analysed using content analysis with an inductive approach.RESULTS: None of the women were familiar with LTBI and assumed they had active TB, causing anxiety about who they might have infected and how it would affect the baby, as well as the fear of being stigmatised. They showed great ability to search for and understand information regarding their condition. Once treatment was initiated, they were motivated to complete it.CONCLUSION: Our findings suggest that the key factors was to provide treatment along with reliable information about LTBI to help patients overcome their concerns and misconceptions.

Retrospective Analysis of 28 Cases of Tuberculosis in Pregnant Women in China

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.

Isoniazid Preventive Therapy in HIV-Infected Pregnant and Postpartum Women

BackgroundThe safety, efficacy, and appropriate timing of isoniazid therapy to prevent tuberculosis in pregnant women with human immunodeficiency virus (HIV) infection who are receiving antiretroviral therapy are unknown.MethodsIn this multicenter, double-blind, placebo-controlled, noninferiority trial, we randomly assigned pregnant women with HIV infection to receive isoniazid preventive therapy for 28 weeks, initiated either during pregnancy (immediate group) or at week 12 after delivery (deferred group). Mothers and infants were followed through week 48 after delivery. The primary outcome was a composite of treatment-related maternal adverse events of grade 3 or higher or permanent discontinuation of the trial regimen because of toxic effects. The noninferiority margin was an upper boundary of the 95% confidence interval for the between-group difference in the rate of the primary outcome of less than 5 events per 100 person-years.ResultsA total of 956 women were enrolled. A primary outcome event occurred in 72 of 477 women (15.1%) in the immediate group and in 73 of 479 (15.2%) in the deferred group (incidence rate, 15.03 and 14.93 events per 100 person-years, respectively; rate difference, 0.10; 95% confidence interval [CI], −4.77 to 4.98, which met the criterion for noninferiority). Two women in the immediate group and 4 women in the deferred group died (incidence rate, 0.40 and 0.78 per 100 person-years, respectively; rate difference, −0.39; 95% CI, −1.33 to 0.56); all deaths occurred during the postpartum period, and 4 were from liver failure (2 of the women who died from liver failure had received isoniazid [1 in each group]). Tuberculosis developed in 6 women (3 in each group); the incidence rate was 0.60 per 100 person-years in the immediate group and 0.59 per 100 person-years in the deferred group (rate difference, 0.01; 95% CI, −0.94 to 0.96). There was a higher incidence in the immediate group than in the deferred group of an event included in the composite adverse pregnancy outcome (stillbirth or spontaneous abortion, low birth weight in an infant, preterm delivery, or congenital anomalies in an infant) (23.6% vs. 17.0%; difference, 6.7 percentage points; 95% CI, 0.8 to 11.9).ConclusionsThe risks associated with initiation of isoniazid preventive therapy during pregnancy appeared to be greater than those associated with initiation of therapy during the postpartum period. (Funded by the National Institutes of Health; IMPAACT P1078 TB APPRISE ClinicalTrials.gov number, NCT01494038.)

Characteristics of miliary tuberculosis in pregnant women after in vitro fertilisation and embryo transfer.

To analyse the clinical characteristics of miliary tuberculosis (TB) in pregnant women after in vitro fertilisation and embryo transfer (IVF-ET). Six pregnant women with miliary TB after IVF-ET between October 2010 and July 2015 were retrospectively analysed. The patients were aged between 29 and 39 years. Fever, cough and dyspnoea were the main symptoms, and started during the first and second trimesters of pregnancy. Erythrocyte sedimentation rate and C-reactive protein were increased. White blood cell count was normal or slightly increased. Tuberculin purified protein derivative and acid-fast smear of sputum tests were negative. T-SPOT®.TB was performed in two cases and the results were positive. Chest computed tomography showed typical miliary nodules. One patient had tuberculous meningitis. Although all patients were cured, the foetuses died. The principal symptoms of miliary TB in pregnant women after IVF-ET were fever and dyspnoea. Physicians should consider the occurrence of miliary TB, particularly in the case of fever of long duration, respiratory symptoms and no response to antibiotic treatment.

Tuberculosis in Pregnancy - a Summary.

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.

Is pulmonary tuberculosis in pregnant women a problem in Ghana? Observations and lessons from the national tuberculosis prevalence project.

Despite appropriate prevention and control measures, tuberculosis (TB) remains a significant contributor to maternal morbidity and mortality. Diagnosis of the disease in pregnancy is usually challenging, as the symptoms may be attributed to the pregnancy. Little is known about the true burden of the disease and its associated risk factors among pregnant women. This study sought to assess the prevalence of TB among pregnant women and associated sociodemographic characteristics in Ghana. The study used nationally representative data gathered from the national TB project in 2013. A total of 1747 pregnant women were sampled from 56 randomly selected diagnostic health centers across the ten regions of Ghana. TB was confirmed with Ziehl-Neelsen staining technique using morning sputum samples from pregnant women who reported coughing for more than 2 weeks. We assessed how the observed TB prevalence differed by some sociodemographic characteristics and other factors. We further examined the regional spatial distribution of pregnant women with TB in the country. Up to 11.2% of the pregnant women had a history of cough during pregnancy. Eighteen (1.1%) cases of TB were confirmed among the pregnant women during the 2-year period, with the Eastern region of the country recording the highest (n = 13, 72%), followed by Volta region ( n = 2, 11.1%). No cases were recorded in five regions. The geographical region of residence was the only determinant of TB in pregnancy significantly associated with TB (P = 0.001). Although the burden of TB was found to be low, appropriate control measures have to be put in place to detect the disease during the early stages of pregnancy to safeguard the health of the expectant mother and the unborn child.

A Situational Analysis of Screening and Treatment of TB in Pregnant Women across 5 Countries

Background: Tuberculosis (TB) is the third leading cause of death among women of reproductive age, and undiagnosed TB among pregnant women can result in poor outcomes for both women and their children. Therefore, it is essential for National Tuberculosis Programs (NTPs) to strengthen their policies and guidelines addressing TB in pregnant women and adopt more efficient screening practices. The purpose of this situational analysis is to identify key approaches to addressing TB in pregnancy and to identify barriers and recommendations for the integration of TB and Antenatal Care (ANC) services. Methods: We conducted an initial desk review of the existing literature and recommendations from international organizations on global strategies to address TB among pregnant women. We developed a multi-country survey to gather information on current practices regarding TB screening and treatment among pregnant women as well as barriers to integration of TB services with ANC services. Results: We received survey responses from five countries (Bangladesh, Indonesia, Myanmar, the Philippines, and Vietnam). Only Myanmar had fully integrated TB and ANC services. While respondents from all countries identified the potential benefits of TB/ANC service integration, the most commonly identified barriers to implementation included lack of management capacity to supervise integrated services, inadequate staff, and lack of knowledge about TB among ANC staff. Conclusion: While countries are aware of the advantages and opportunities associated with integrating TB services into other health care services, the implementation of such integration remains a challenge. Integration of services is one of the key recommendations of this study. Where services have been fully integrated, operational research is needed to evaluate its impact.

Epidemiology of HIV and Tuberculosis in pregnant women, South West Nigeria

Pregnant women remain the most vulnerable high-risk population to the devastating impact of the on-going human immunodeficiency virus (HIV) generalized epidemic and co-infection with Tuberculosis in Nigeria. By the end of 2017, the country ranked the second highest in adult HIV-infected individuals and the highest population of orphans due to AIDS in sub-Saharan Africa. We assessed the epidemiology of HIV among pregnant women across ten facilities in south-west Nigeria. This is a cross-sectional study design in which 353 pregnant women randomly selected across ten health care facilities in two states in south west Nigeria. This study was conducted between January and May 2015. HIV testing was conducted and active tuberculosis screening was implemented using the fluorescence microscopy. In addition, a structured questionnaire was administered to elicit risk factors of HIV infection and syndromic Tuberculosis in the study population. We found a 5.1% (18/353:95% CI:3.0%-8.0%) rate of HIV and 0% active tuberculosis in the study population. HIV positive pregnant women were 6 times more likely to have blood transfusion with greater odds of infection found in pregnant women with history of blood transfusion in the previous three months (OR:3.27, 95% CI:0.44-24.36). Pregnant women who tested HIV negative had 70% reduction in odds of infection (OR:0.21:95% CI:0.06-0.77). This study suggests a possible strong epidemiological link between HIV infection and recent blood transfusion among pregnant women attending ante-natal clinics in south west Nigeria. We therefore recommend further study to develop a more robust estimate of blood transfusion and the risk of HIV in pregnant women in Nigeria.

Symptom screening for active tuberculosis in pregnant women living with HIV.

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the accuracy of the four-symptom screen (cough, fever, night sweats, or weight loss) for identifying active TB in pregnant PLHIV who are screened in an outpatient or community setting. To investigate potential sources of heterogeneity of the accuracy of the four-symptom screen between studies including: ART status, CD4 cell count, gestational age, pregnancy stage (pregnancy vs. postpartum), screening test definition of cough (any cough vs. cough greater than 2 weeks).To describe the accuracy of single symptoms included within the four-symptom screen, additioal symptoms or symptom combinations, for identifying active TB in pregnant PLHIV. For example, additional symptoms may include failure to gain weight or fatigue.

Bedaquiline and Linezolid for Extensively Drug-Resistant Tuberculosis in Pregnant Woman

A woman with extremely drug-resistant tuberculosis treated with a drug regimen including linezolid and bedaquiline during her last 3 weeks of pregnancy gave birth to a child without abnormalities. No fetal toxicities were noted by 2 years after delivery. This drug combination might be safe during the late third trimester of pregnancy.

Congenital tuberculosis in an extremely preterm infant conceived after in vitro fertilization: case report

BackgroundCongenital tuberculosis is a rare manifestation of tuberculosis. The diagnosis is often delayed, especially in preterm neonates because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy.Case PresentationWe report a case of congenital tuberculosis in an infant born at 24 weeks of gestation to a mother who presented with uncontrolled seizures during preterm labor. Maternal diagnosis was initially made by placental pathology, and later confirmed by isolation of Mycobacterium tuberculosis in urine, gastric aspirates and sputum. Full screening was performed on the newborn infant, and both mother and infant were successfully treated for tuberculosis with a four drug regimen.ConclusionPregnancy can exacerbate latent tuberculosis and women originating from endemic areas are especially susceptible. The best way to prevent congenital tuberculosis is to have a high index of suspicion and identify and treat tuberculosis in pregnant women.