Author: Bothamley, Graham H

Source: Expert Review of Obstretrics and Gynecology, Volume 4, Number 5, September 2009 , pp. 555-563(9)

Publisher: Expert Reviews

Abstract:

Tuberculosis is a common illness in the world, especially in sub-Saharan Africa, the Indian subcontinent, the former Soviet Union states and China. In western Europe and North America, TB remains common in those with concurrent HIV infection, the homeless and those with drug and alcohol addiction. In pregnancy, the symptoms of TB may be confused with normal features of pregnancy. Sputum examination and a shielded chest x-ray are appropriate tests in those at a high risk of active TB. Extrapulmonary TB is more common in women and in pregnancy, and diagnosis may be delayed. Tuberculin skin testing and the new blood tests (IFN-γ-release assays) may be useful in these circumstances and also in the diagnosis of latent TB. HIV coinfection is an important cause of mortality and morbidity. Treatment of TB in pregnancy is safe and reduces the fetal complications associated with active disease. Chemoprophylaxis for latent TB infection may also be taken during pregnancy. Drug-resistant TB is an increasing problem in individuals from sub-Saharan Africa and eastern Europe, with a high mortality rate. Treatment with aminoglycosides is associated with fetal hearing and occasional balance problems, but the adverse effects of other second-line drugs are not well documented. The implications of infection control following the diagnosis of TB in pregnancy should be met with a well-planned response. Bacillus Calmette-Guérin vaccination should be given to neonates where the incidence of TB is greater than 40 per 100,000, unless they have HIV coinfection. TB is an important cause of infertility.

Keywords: bacille Calmette-Guérin; HIV; IFN-γ-release assay; latent TB infection; pregnancy; TB; tuberculin

Document Type: Research article

DOI: http://dx.doi.org/10.1586/eog.09.39

Affiliations: 1: NE London TB Network, Homerton University Hospital, Homerton Row, London E9 6SR, UK., Email: graham.bothamley@homerton.nhs.uk

Publication date: 2009-09-01

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