TB

Question 1

Define TB in pregnancy.

Answer 1

Infection with Mycobacterium tuberculosis in pregnancy.

Question 2

What is the aetiology of TB in pregnancy?

Answer 2

Aerosol transmission

Question 3

What are risk factors for TB in pregnancy?

Answer 3

HIV-infection

Recent tuberculin skin test conversion

Homeless

Injection drug users

Cigarette smokers

Immunocompromised individuals (e.g. people with diabetes, prolonged corticosteroid therapy, end-stage renal disease, malnutrition, or haematological malignancies)

Question 4

Summarise the epidemiology of TB in pregnancy.

Answer 4

Relatively rare in the UK

Question 5

What are symptoms of TB in pregnancy?

Answer 5

Cough

Fever

Anorexia

Weight loss

Malaise

Night sweats

Question 6

What are signs of TB in pregnancy?

Answer 6

Haemoptysis

Psychological symptoms

Abnormal chest auscultation

Clubbing

Erythema nodosum and erythema induratum

Question 7

What investigations should be performed for TB in pregnancy?

Answer 7

Chest x-ray

Sputum acid-fast bacilli smear

Sputum culture

FBC (full blood count)

Nucleic acid amplification tests (NAAT)

Question 8

What is the management for TB in pregnancy?

Answer 8

Latent TB Infection: 4-month daily regimen of rifampin (RIF) (4R); 3-month daily regimen of isoniazid (INH) and RIF (3HR); 6- or 9-month daily regimen of INH (6H or 9H) , with pyridoxine (vitamin B6) supplementation.

TB Disease: The preferred initial treatment regimen is INH, rifampin (RIF), and ethambutol (EMB) daily for 2 months, followed by INH and RIF daily, or twice weekly for 7 months (for a total of 9 months of treatment).

Question 9

What are complications associated with TB in pregnancy? What is the prognosis of TB in pregnancy?

Answer 9

Spontaneous abortion, small for date uterus, preterm labour, low birth weight, and increased neonatal mortality. Congenital TB though rare, is associated with high perinatal mortality.