Tuberculosis In Pregnant Women Research Articles

Features of the course and effectiveness of treatment of tuberculosis in pregnant women with different HIV status

The study presents the results of comparing the social status and the efficiency of TB treatment in pregnant women with or without HIV treated in Krasnoyarsk Regional TB Clinic № 1 in the years 2010–2014. It is based on a retrospective analysis of health cards of 133 pregnant TB patients divided into groups: Group 1 (TB), n=109; Group 2 (TB and HIV), n=24. More than a half of the women (51,3% and 54,1% accordingly) were new TB patients, the others had been previously treated for TB. A moderate immunodeficiency was more often detected in co-infected pregnant women (mean CD4+ lymphocyte count being 387 cells/ml), although in 4 patients the CD4 count was lower than 200 cells/ml. The registered rates of bacterioexcretion and lung disintegration were practically the same (57,7% and 58,3% versus 53,2% and 54,1% accordingly); MDR TB was diagnosed in 51,1% in Group 1 and in 60,0% in Group 2. Results: Patients of both groups had various social problems. However, the most aggravating medico-social factor among the co-infected women was active drug abuse during pregnancy (proved in 37,5%). The clinical course of TB in patients with HIV was severer, they more often developed acute forms of the disease. Preterm delivery was more frequent in TB/HIV cases (46,1% vs. 12,3%, p<0,01). Children born by the women with HIV co-infection showed signs of prematurity and intrauterine growth retardation more often than those born by HIV-negative patients (50,0% vs. 12,3%, p<0,01). Treatment efficiency for TB was authentically less in co-infected cases (33,4% vs. 58,7%, p<0,01). TB recurrence was more often registered in HIV-positive patients (25,0% vs. 3,1%, p<0,01). As for chemotherapy tolerance, treatment adherence or lethality rate, no authentic differences between the groups have been revealed.

TUBERCULOZĂ DISEMINATĂ LA O GRAVIDĂ SERONEGATIVĂ HIV CU SARCINĂ ÎN 12 SĂPTĂMÂNI DE EVOLUŢIE OBŢINUTĂ PRIN FERTILIZARE IN VITRO

Information on the outcome of extrapulmonary tuberculosis in pregnant women is limited. We present particular clinical and outcome aspects in a pregnant HIV negative woman (with pregnancy after in vitro fertilization) with tuberculosis at multiple extrapulmonary sites. In addition, we will describe the paradoxical reaction with appearance of cerebral tuberculomas after 7 months of antituberculous therapy initiation, most probably in the context of a immune reconstitution inflammatory syndrome (IRIS).

Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (I): Epidemiology and diagnosis. Congenital tuberculosis

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.

Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (ii): Prophylaxis and treatment

In pregnant women who have been exposed to tuberculosis (TB), primary isoniazid prophylaxis is only recommended in cases of immunosuppression, chronic medical conditions or obstetric risk factors, and close and sustained contact with a patient with infectious TB. Isoniazid prophylaxis for latent tuberculosis infection (LTBI) is recommended in women who have close contact with an infectious TB patient or have risk factors for progression to active disease. Otherwise, it should be delayed until at least three weeks after delivery. Treatment of TB disease during pregnancy is the same as for the general adult population. Infants born to mothers with disseminated or extrapulmonary TB in pregnancy, with active TB at delivery, or with postnatal exposure to TB, should undergo a complete diagnostic evaluation. Primary isoniazid prophylaxis for at least 12 weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Isoniazid for 9 months is recommended in LTBI. Treatment of neonatal TB disease is similar to that of older children, but should be maintained for at least 9 months. Respiratory isolation is recommended in congenital TB, and in postnatal TB with positive gastric or bronchial aspirate acid-fast smears. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. Breastfeeding is not contraindicated, and in case of mother-infant separation expressed breast milk feeding is recommended.

Microcalcificaciones cerebrales en un recién nacido con tuberculosis congénita

Tuberculosis is a serious public health problem worldwide. In 2012, the World Health Organization estimated 8.6 million new cases and 1.3 million deaths due to the disease. In 2011, the incidence in Colombia was 24 cases per 100,000 inhabitants. There is little information about tuberculosis in pregnant women, and congenital infection is considered a rare disease that is difficult to diagnose, leads to high mortality, and may be confused with tuberculosis acquired after birth. In addition, it has been associated with HIV infection in mothers and infants. Moreover, there is increasing incidence of congenital syphilis in the world. In Colombia, the prevalence is 2.5 cases per 1,000 births and its frequency in the Instituto Materno Infantil-Hospital La Victoria is one case per 57 births. We report the case of a newborn under treatment for congenital syphilis and in whom microcalcifications were found in a transfontanelar ultrasound. This finding warned about the existence of another infectious agent. PCR was negative for cytomegalovirus, and IgM titers for toxoplasma, rubella and herpes I and II were also negative.After learning about a history of incomplete treatment for tuberculosis in the mother, we suspected the presence of an infection by the tubercle bacillus in the newborn. No acid-fast bacilli were demonstrated in three gastric juice samples. The IS6110 PCR assay was found positive in cerebrospinal fluid and urine, but not in blood. The newborn was treated with crystalline penicillin for 10 days along with isoniazid, rifampicin, pyrazinamide and streptomycin. The patient is currently under clinical monitoring.

486: Comparison of the QuantiFERON-TB Gold assay and tuberculin skin test in prenatal screening for tuberculosis in pregnant women, with prior BCG vaccination

CONCLUSION: 1. 84% of respondents are salaried employees and have their PLI paid for by an institution. 2. Significant percentages are unsure or have no knowledge of their type of PLI policy or policy limits. 3. Two thirds experienced at least one liability claim. 4. Two thirds of claims were dropped without payment, about /4 were settled with payment and < 10% went to trial with majority of Defense verdicts. 5. Experience with liability claims prompted significant changes in practice patterns and the practice of defensive medicine.

Churg-Strauss Syndrome Treated as Pulmonary Tuberculosis in Pregnant Woman: A Case Report

Churg-Strauss Syndrome Treated as Pulmonary Tuberculosis in Pregnant Woman: A Case Report

Tuberculosis in pregnancy

Tuberculosis (TB) remains an important infection in women globally. It is responsible for 700 000 deaths annually and is a major contributor to maternal mortality. Mycobacterium tuberculosis/HIV co-infection is common in areas of high HIV prevalence, and may be associated with significant perinatal and maternal morbidity. Improved diagnosis and treatment of TB in pregnant women are important interventions for both maternal and child health. Controlling TB in pregnancy in high-prevalence areas requires a range of interventions, including active TB screening in pregnant women, TB preventative therapy for HIV-infected pregnant women, treatment of active TB and linking mothers and children to TB care services.

Latent tuberculosis among pregnant mothers in a resource poor setting in Northern Tanzania: a cross-sectional study

BackgroundUntreated latent TB infection (LTBI) is a significant risk factor for active pulmonary tuberculosis, hence predisposing to adverse pregnancy outcomes and mother to child transmission. The prevalence of latent tuberculosis in pregnancy and its association, if any, with various socio-demographic, obstetric and clinical characteristics was evaluated.MethodsNorthern Tanzania was chosen as the study site. In a cross-sectional study, a total of 286 pregnant women from 12 weeks gestational age to term were assessed. Screening was undertaken using an algorithm involving tuberculin skin testing, symptom screening in the form of a questionnaire, sputum testing for acid fast bacilli followed by shielded chest X-rays if indicated. HIV serology was also performed on consenting participants.ResultsPrevalence of latent infection ranged between 26.2% and 37.4% while HIV sero prevalence was 4.5%. After multivariate logistic analysis it was found that age, parity, body mass index, gestational age, and HIV sero status did not have any significant association with tuberculin skin test results. However certain ethnic groups were found to be less vulnerable to LTBI as compared to others (Chi square = 10.55, p = 0.03). All sputum smears for acid fast bacilli were negative.ConclusionThe prevalence of latent tuberculosis in pregnant women was found to be relatively high compared to that of the general population. In endemic areas, socio-demographic parameters alone are rarely adequate in identifying women susceptible to TB infection; therefore targeted screening should be conducted for all pregnant women at high risk for activation (especially HIV positive women). As opposed to the current policy of passive case detection, there appears to be an imminent need to move towards active screening. Ethnicity may provide important clues into genetic and cultural differences which predispose to latent tuberculosis, and is worth exploring further.

Pregnancy and tuberculosis: to assess tuberculosis cases in pregnancy in a developing region retrospectively and two case reports

PREGNANCY AND TUBERCULOSIS (TB): To assess TB cases during pregnancy in a developing region retrospectively and to present two case reports. Since TB cases activated by HIV infection during pregnancy are well reported in the literature, we aimed to investigate the aggressiveness of pulmonary TB among pregnant women and to assess the effects of TB on the fetus in Kutahya, an area where HIV positive cases are not seen. The medical records between 2000 and 2005 of the Provincial Health Directorate and Dispensary Against Tuberculosis in Kutahya were reviewed and analyzed retrospectively. Between 2000 and 2005, 667 pulmonary TB cases were examined in the Kutahya region. Of these, 106 occurred in women at reproductive ages between 20 and 44. All were HIV negative cases. In this area, five TB cases were found during pregnancy. There were three cases seen in the first trimester, but pregnancy was ended by curettage. Two women had pulmonary TB and gave birth. Five cases were evaluated as class 1 TB. During and after pregnancy, isoniazid, rifampin, ethambutol, and pyrazinamide (INH + RFP + ETB + PRZ) were used for the treatment. Resistance to anti-TB drugs was not seen during the treatment. Neither congenial nor neonatal TB was seen. Generally, TB is expected to be more aggressive during pregnancy. Since our cases were HIV negative, it can be thought that TB did not progress aggressively. Less aggressiveness and non-resistance to TB treatment in HIV-negative pregnant women compared with HIV-positive women were observed. Therefore, HIV infection results in greater mortality than the triple combination of human immunodeficiency virus, mycobacterium TB, and pregnancy. Besides, the advance of TB in pregnant women was not different from that in non-pregnant women in Kutahya. The fetus and the newborn were not affected. INH, RFP, ETB, and PRZ were used for therapy.

Combining PMTCT With Active Case Finding for Tuberculosis

Tuberculosis (TB) is the preeminent manifestation of HIV infection and has become a leading cause of maternal mortality and morbidity in high HIV-prevalence settings. Active TB in pregnant women has potentially serious consequences for fetuses and newborns. In Soweto, South Africa, there is a more than 90% uptake of voluntary counseling and HIV testing during routine antenatal care, and almost one third of pregnant women are HIV-infected. The posttest counseling session of the prevention of mother-to-child transmission program provides an opportunity to screen HIV-infected pregnant women for TB. In this study, 370 HIV-infected pregnant women were screened for symptoms of active TB by lay counselors at the posttest counseling session. If symptomatic, they were referred to nurses who investigated them further. Eight women were found to have previously undiagnosed, smear-negative, culture-confirmed TB (2160/100,000). The mean CD4 count in those with active TB compared to those without TB was 276 x 10(6) cells per liter vs 447 x 10(6) cells per liter (P = 0.051). Symptoms most associated with active TB were hemoptysis and fever. We conclude that rates of TB in HIV-infected pregnant women are high, and screening for TB during routine antenatal care should be implemented in high HIV-prevalence settings.

Enfermedad tuberculosa durante el embarazo

Tuberculosis in pregnant woman has a excellent evolution with adecuate drugs. However, morbility and mortality during pregnancy is very important when patient does not take medication. We report three cases of pregnant women with tuberculosis wich occurred in our hospital.

Tuberculosis and pregnancy – a provincial study (1990–1996)

Background: Several studies suggest that physiological changes in pregnancy mimic early symptoms of tuberculosis. If true, this could influence the diagnostic delay of the disease and the outcome of pregnancy. Methods: From the register of the Public Health Centre, all female patients with culture-proven tuberculosis aged between 22 and 35 years in the Province of Zeeland in the period 1990–1996 have been identified. Data on symptoms, delay, therapy and outcome of the pregnancy have been collected. Risk factors for an early diagnosis have been identified. Results: In nearly one-third of the patients with tuberculosis (n=14), it has been possible to make a presumptive diagnosis on the basis of a chest X-ray only. Patients with tuberculosis associated with pregnancy are more likely than their non-pregnant counterparts to have non-specific symptoms which are, at most, moderate (p=0.002). Diagnosis has also been hampered by non-cavernous, smear-negative presentation of the disease. In addition, women with pulmonary tuberculosis associated with pregnancy are more likely to postpone having a chest X-ray taken (p=0.02), which contributes to the delay. Conclusion: As the clinical features of tuberculosis in pregnancy are moderate, a high index of clinical suspicion is necessary. Nevertheless, the favourable outcome suggests that (if all risk factors are taken into account) lung tuberculosis in pregnant women in The Netherlands can be discovered sufficiently early within the limits of the current screening programme to prevent harm to mother or child.

Tuberculosis: an update.

1. Rosalind S. Abernathy, MD* 1. 2. *Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Pediatric Consultant, Tuberculosis, Arkansas State Department of Health, Little Rock, AR. 1. The majority of tuberculosis cases in children are from high-risk populations, that is, African-Americans, Hispanics, immigrants, and those living in poverty and in the inner cities. 2. The only acceptable tuberculin skin test is the intradermal Mantoux test with purified protein derivative (PPD), and three levels of positivity now are accepted. Children exposed to active disease who have findings suggestive of tuberculosis or who have human immunodeficiency virus (HIV) infection are positive at 5 to 9 mm; other high-risk groups are positive at 10 mm. 3. Diagnosis of childhood tuberculosis depends on a high index of suspicion coupled with suggestive epidemiologic data, tuberculin skin test results, and chest radiographic findings. Cultures are not routinely positive, and results are available only after treatment must be started. 4. Treatment is a uniform 6-month course of isoniazid, rifampin, and pyrazinamide for 2 months followed by 4 months of isoniazid and rifampin daily or twice weekly. Additional drugs are needed in cases of drug resistance. 5. Chemoprophylaxis for all children who have a positive tuberculin reaction will prevent future disease. Despite the availability of effective antituberculosis drugs since 1952, tuberculosis remains an important cause of morbidity, mortality, and health care cost in the United States. Tuberculosis case rates declined at a rate of 6% annually for more than 20 years until 1985 when they leveled off (Fig. 1⇓). Factors responsible for this include human immunodeficiency virus (HIV) infection; immigration of individuals from countries where tuberculosis rates are 10 to 30 times that of the United States; transmission of disease in hospitals, homeless shelters, and prisons; and poverty, overcrowded living, and poor access to medical care. While all this was occurring, funds for tuberculosis control by public health programs declined. Fortunately, the number of cases reported annually has decreased by 8.7% in the past 2 years, probably …

Tuberculosis: current implications and management in obstetrics.

After years of decline, tuberculosis has again emerged as a serious public health issue. Following the introduction of effective chemotherapy at mid-century, cases of tuberculosis decreased until 1986. Since that time, the number of cases of tuberculosis have dramatically increased, particularly among young persons. The reemergence of tuberculosis is localized to urban areas and is linked to the increase in the incidence of human immunodeficiency virus infection and drug resistance. Since pregnant women are at risk for tubercular infection, an effective method exists to identify women who are asymptomatically infected, provide them with treatment to prevent progression of disease, and investigate their contacts. This review will discuss the issues of diagnosis and treatment of asymptomatic infection and active tuberculosis in pregnant women. Additionally, the need for universal screening of all prenatal patients and the benefit and potential perinatal toxicity of chemotherapy in both immunocompetent patients and those infected with human immunodeficiency virus will be addressed.

Management of Tuberculosis in Pregnancy and the Newborn

Tuberculosis in pregnant women and their offspring is a serious and sometimes life-threatening infection. A high index of suspicion is a prerequisite for proper diagnosis. Early detection is essential since treatment is successful in these patients.

HEARING LOSS IN INFANTS OF TUBERCULOUS MOTHERS TREATED WITH STREPTOMYCIN DURING PREGNANCY.

IN a recent study1 of the etiology of hearing loss in 200 preschool children the prenatal administration of streptomycin or dihydrostreptomycin for treatment of tuberculosis in pregnant women was not encountered. In the subsequent 100 cases, however, 2 children with congenital hearing loss were found whose mothers had received streptomycin for the treatment of tuberculosis during pregnancy.The purpose of this report is to describe these 2 cases and to review the literature concerning congenital hearing loss from this cause.Case ReportsCase 1. D.P. was born on December 28, 1959, after a full-term pregnancy complicated by a recurrence of . . .

Pulmonary Tuberculosis in Pregnant Women: Case-Finding in Board of Health Prenatal Clinics

Pulmonary Tuberculosis in Pregnant Women: Case-Finding in Board of Health Prenatal Clinics

Routine radiography for tuberculosis in pregnant women.

Routine radiography for tuberculosis in pregnant women.

The relation of child-bearing and child-rearing to pulmonary tuberculosis

Summary 1. The relation of child-bearing and child-rearing to pulmonary tuberculosis is discussed. 2. The need for early diagnosis of unsuspected tuberculosis in pregnant women is stressed, and the desirability for a radiological examination of the chest as an integral part of antenatal supervision is advocated. 3. Active tuberculous lesions should be treated as if no pregnancy existed, and inactive cases should be regularly and carefully observed and supervised. Active cases may be allowed to become pregnant if the disease is controlled by therapy, or if the parents wish to risk all for a living child. The psychological reaction of the mother is of paramount importance. In active cases of known tuberculosis the practice of contraception is advised when no religious scruples preclude. 4. The second stage of labour should be diminished in time, and the puerperium should be prolonged. Lactation should be forbidden. 5. The child should not be nursed or fed by a mother who has active disease, and should be given B.C.G. within the first week after birth whether the disease of the mother is active or inactive. Chemotherapy given for the maternal lesion does not affect the child. 6. No special adverse influence upon the course of tuberculosis is attributable to child-bearing, but child-rearing may give rise to deterioration of the maternal disease. Retrogression, when it occurs, is often due to other factors which would cause a breakdown even if no pregnancy existed. 7. Within the broad limits of generalisation, each individual case must be assessed on its merits, including physiological, psychological and pathological, as well as social and economic factors.