TOG Flashcards
Which countries have the highest burden of TB?
In resource limited countries
Africa + southest asia
What is the prevalence of TB among pregnant women in low prevalence countries?
0,06 - 0,25 %
What is the prevalence of TB among pregnant women HIV positive?
0,7 - 11 %
What is the pathophysiology behind TB?
Mycobacterium tuberculosis
Non spore forming/ aerobic/ non motile bacillus
What is the percentage of healthy adults will acquire infection with TB during their lifetime?
10 %
What is the percentage of immunocompromised individuals latent TB ( LTBI) will devlop reactivation of TB ?
10 %
What are the outcomes of a primary infection with TB ?
🚩- latent TB infection ( LTBI / asymptomatic + non infectious)
🚩- Primary TB ( within 2 years of infection)
🚩- secondary TB ( those with immunosuppression) such as HIV / autoimmune diseases / pregnancy
[ reactivation of LTBI & more prone to extra pulmonary TB ]
What is the percentage of active TB present as extra pulmonary TB? What are the sites?
20 %
Most common: cervical lymph nodes ( 30 % of cases)
Other sites: CNS / spinal cord / abdomin / pericardium
What are the clinical presentation of TB in pregnancy according to who?
Fever / night sweats/ cough/ weight loss
📌Diagnosis may be delayed owing to symptoms overlapping normal physiological changes occur in pregnancy.
How are investigations for TB can be classified?
📌 screening tests:
🍀TB skin test ( TST)
🍀interferon gamma release assay
( IGRA)
📌 confirmatory tests:
🍀 microscopy
🍀 culture & sensitivity
📌 additional: imaging studies
How tuberculosis skin test ( Mantoux) is done? Dose pregnancy alter the outcome of the result ?
TST: by administration of purified protein derivative ( PPD) intradermal: is measured 48 - 72h
( 5 - 15 mm)
🚩pregnancy DOESN’T alter the outcome of the result.
Does IGRA ( interferon gamma release assay) influenced by BCG vaccination?
No
In pulmonary TB what is the percentage of sputum positive cases ?
2/3
👉 staining techniques may miss 1/3 of active cases
What is the traditional medium for culture & sensitivity of TB?
Lowenstein Jensen
Takes 4-8 weeks
Are anti TB drugs contraindicated in pregnancy or breastfeeding?
The benefits of treating TB in pregnancy outweigh any risk of treatment
And is not a contraindication in breastfeeding
What is the protocol of medications in TB in pregnancy?
🚩First 2 months; 4 antibiotics
RIFAMPICIN
IHN
Pyrazinamide
Ethambutal
[ 3 times a week]
🚩THEN : 6 months IHN + RIFAMPICIN
What to monitor while the woman is on anti TB drugs?
LFTs at least monthly
Any jaundice 👉stop
Which anti TB drug is contraindicated in pregnancy?
Streptomycin
What is the role of steroids in the treatment of TB?
As adjunctive therapy in patients with tuberculosis pericarditis
Meningeal tuberculosis
What are the proposed mechanisms of infection in the fetus in TB ?
1- fetal ingestion of infected fluid
2- aspiration of the fluid
3- hematogenous infection via umbilical vein
