Tuberculosis in PregnancyTuberculosis in Pregnancy

Max Brinsmead MB BS PhDMax Brinsmead MB BS PhDMay 2015May 2015

IncidenceIncidence

In 1990 there were 6.6 million cases of TB In 1990 there were 6.6 million cases of TB worldwideworldwide

By 2008 this had risen to 9.4 millionBy 2008 this had risen to 9.4 million

30% of those will be in women30% of those will be in women And 30% of these will be women of child-bearing ageAnd 30% of these will be women of child-bearing age

Pregnancy per se does NOT increase the risk of Pregnancy per se does NOT increase the risk of TB infectionTB infection

Concomitant HIV infection is the biggest problemConcomitant HIV infection is the biggest problem

DiagnosisDiagnosis Can be quite difficult when symptoms are Can be quite difficult when symptoms are

nonspecificnonspecific And resources are limitedAnd resources are limited Symptoms of ...Symptoms of ...

MalaiseMalaise FatigueFatigue Weight lossWeight loss Cough & haemoptysisCough & haemoptysis ScrofulaScrofula AscitesAscites

Investigate by sputum exam for AFBInvestigate by sputum exam for AFB CXR can be negative in ≈1:6 cases pulmonary TBCXR can be negative in ≈1:6 cases pulmonary TB

Newer tests such as the Quanti-FERON-TB gold Newer tests such as the Quanti-FERON-TB gold in tube test promisingin tube test promising

Effect of TB on PregnancyEffect of TB on Pregnancy

If adequately treated the prognosis is good and If adequately treated the prognosis is good and TB per se should not affect outcomeTB per se should not affect outcome

But poor obstetric outcomes are common when But poor obstetric outcomes are common when socio economic circumstances are taken into socio economic circumstances are taken into accountaccount

Especially when there is concomitant HIVEspecially when there is concomitant HIV

There is a risk of mother to child transmissionThere is a risk of mother to child transmission

Mother to Child Transmission of TBMother to Child Transmission of TB

Can occur...Can occur... In utero – transplacentalIn utero – transplacental During labour – ingestionDuring labour – ingestion From breast feeding with TB breast abscessFrom breast feeding with TB breast abscess But most occurs by direct exposure to aerosol droplets But most occurs by direct exposure to aerosol droplets

during postnatal contactduring postnatal contact

Newly diagnosed and incompletely treated Newly diagnosed and incompletely treated mothers should be separated from their infantsmothers should be separated from their infants

And all infants should receive prophylactic And all infants should receive prophylactic IsoniazidIsoniazid

Treatment of Mothers with TBTreatment of Mothers with TB Should be the same as for non-pregnant Should be the same as for non-pregnant ♀♀ But try to avoid StreptomycinBut try to avoid Streptomycin 2 months of ...2 months of ...

EthambutalEthambutal IsoniazidIsoniazid

Monitor liver function testsMonitor liver function tests RifampicinRifampicin PyrazinamidePyrazinamide

Follow by 4 months of...Follow by 4 months of... Isoniazid plus RifampicinIsoniazid plus Rifampicin

Compliance is a problemCompliance is a problem Drug resistance is a problemDrug resistance is a problem

And the safety of 2And the safety of 2ndnd line therapy in pregnancy is unknown line therapy in pregnancy is unknown If there is concomitant HIV try to treat that first if If there is concomitant HIV try to treat that first if

possiblepossible Be aware that drug interactions with HAART occurBe aware that drug interactions with HAART occur

Any Questions or Any Questions or Comments?Comments?

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