TB in pregnancy TOG 2023 Flashcards
Global burden TB
0 Which area has highest incidence of TB
Highest mortality from TB
Incidence - South east asisa
Deaths - SEA
Rates of TB in UK
6.9/100,000
Highest risk of developing TB when in UK
1st 5 years
Most common clinical form of TB
Pulmonary - Ghon focus
What proportion present as extra pulmonary TB
20%
Most common in UK cervical lymph node
If immunocompromised or HIV +ve most common presentation
Extra-pulmonary
Most common Sx TB
Fever
Night sweats
Cough
Weight loss
What is STOP programme
Stop TB in pregnancy = screen migrant women from high prevalence countries for latent TB
New migrants registering with GP offered screening for latent TB
What are the investigations for TB
Screening tests
○TB skin test (TST)
○Interferon gamma release assay (IGRA)
Confirmatory tests
○Microscopy
○Culture and sensitivity
Additional tests
○Imaging studies
When is false +ve seen in Tb skin test
previous BCG vaccination, previou stuberculous infection and infection with non-tuberculous mycobacterium
When is false -ve seen with TB skin test
Recent TB infection,immunocompromised status, sarcoidosis, non-Hodgkin’slymphoma and recent live vaccination with measlesor chickenpox
New C-Tb test - fewer false +ve
Are the skin test results effected by BCG?
Is the interferon gamma release assay?
Skin test - Yes
IGRA - No
What stain used for microscopy
Ziehl-Neelsen - identify acid fast bacilli
Can miss 1/3rd active cases
How long do results from culture and sensitive take?
4-8 weeks for culture
further 6-8 for sensitive
In culture +ve Tb what proportion have normal CXR
14%
Flow diagram explain management of suspect TB
Effect of pregnancy on TB
- Moren susceptible to TB - primary/reativeation
- Dx more challenging
Effect of TB on pregnancy
- Anaemia 41%
- Preamaturity 32%
- SGA 22%
- Oligohydarmnios
If HIV +ve increase risk of reactivation
20 X
21 X higher rate of TB than general population
Increase risk of complications
Treatment of TB in prengnay
Same as non pregnancy
2 months all 4 drugs
4 months Isoniazid/Rifampixin
(if HIV further 10 months of 2 drugs)
Drug given to alongside isoniazid
Pyridoxine 10 mg/day
What additional dug of neurological TB
Steroids - Dex or pred for 4-8 weeks
Effect of streptomycin in pregnancy?
15% deafness
Not advised in pregnancy
Treatment for latent TB, when recommended?
isoniazid for 6 months or a combination of both isoniazidand rifampicin for 3 months.
If HIV +ve
Main SE to monitor for?
Hepatoxicity - more likely 3rd/PP
Difference Congenital and neonatal TB
Congenital - acquired AN or intrapartum
Neonatal - PP
Perinatal - covers both
Where is the primary focus in neonates?
Liver
Miliary pattern on CXR
How can perinatal TB be Dx
Placental histology/culture
CXR
Aspirates
Presentation in neonate
Presentations include respiratory distress, failureto thrive, irritability, lymphadenopathy, pyrexia of unknown origin,unexplained anaemia and hepatosplenomegaly.
Perinatal TB mortality rate
- Treated
- Not treated
Treated - 20%
Not treated 40%
If active maternal TB and no perinatal TB - what to do
isoniazid preventive therapy at 10 mg/kg/day is recommendedfor 6 months along with pyridoxine
Can mother breast with TB
Once completes at least 2 weeks for treatment
- No if infection HIV/breast TB/multi drug resistance
In UK which neonates should have TB vaccine?
In the UK the BCG vaccine is recommended for neonates whose parents or grandparents were born in a country where the annual incidence of TB is 40/100 000 or greater, or if a newborn baby is living in areas of the UK where the annual incidence of TB is 40/100 000 or greater.
When can BCG be given to neonates of HIV mothers
If HIV negative at 12-14 weeks and exclusively bottle fed
