TOG

Question 1

Which countries have the highest burden of TB?

Answer 1

In resource limited countries
Africa + southest asia

Question 2

What is the prevalence of TB among pregnant women in low prevalence countries?

Answer 2

0,06 - 0,25 %

Question 3

What is the prevalence of TB among pregnant women HIV positive?

Answer 3

0,7 - 11 %

Question 4

What is the pathophysiology behind TB?

Answer 4

Mycobacterium tuberculosis
Non spore forming/ aerobic/ non motile bacillus

Question 5

What is the percentage of healthy adults will acquire infection with TB during their lifetime?

Answer 5

10 %

Question 6

What is the percentage of immunocompromised individuals latent TB ( LTBI) will devlop reactivation of TB ?

Answer 6

10 %

Question 7

What are the outcomes of a primary infection with TB ?

Answer 7

🚩- 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 ]

Question 8

What is the percentage of active TB present as extra pulmonary TB? What are the sites?

Answer 8

20 %
Most common: cervical lymph nodes ( 30 % of cases)
Other sites: CNS / spinal cord / abdomin / pericardium

Question 9

What are the clinical presentation of TB in pregnancy according to who?

Answer 9

Fever / night sweats/ cough/ weight loss
📌Diagnosis may be delayed owing to symptoms overlapping normal physiological changes occur in pregnancy.

Question 10

How are investigations for TB can be classified?

Answer 10

📌 screening tests:
🍀TB skin test ( TST)
🍀interferon gamma release assay
( IGRA)
📌 confirmatory tests:
🍀 microscopy
🍀 culture & sensitivity
📌 additional: imaging studies

Question 11

How tuberculosis skin test ( Mantoux) is done? Dose pregnancy alter the outcome of the result ?

Answer 11

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.

Question 12

Does IGRA ( interferon gamma release assay) influenced by BCG vaccination?

Answer 12

No

Question 13

In pulmonary TB what is the percentage of sputum positive cases ?

Answer 13

2/3
👉 staining techniques may miss 1/3 of active cases

Question 14

What is the traditional medium for culture & sensitivity of TB?

Answer 14

Lowenstein Jensen
Takes 4-8 weeks

Question 15

Are anti TB drugs contraindicated in pregnancy or breastfeeding?

Answer 15

The benefits of treating TB in pregnancy outweigh any risk of treatment
And is not a contraindication in breastfeeding

Question 16

What is the protocol of medications in TB in pregnancy?

Answer 16

🚩First 2 months; 4 antibiotics
RIFAMPICIN
IHN
Pyrazinamide
Ethambutal
[ 3 times a week]
🚩THEN : 6 months IHN + RIFAMPICIN

Question 17

What to monitor while the woman is on anti TB drugs?

Answer 17

LFTs at least monthly
Any jaundice 👉stop

Question 18

Which anti TB drug is contraindicated in pregnancy?

Answer 18

Streptomycin

Question 19

What is the role of steroids in the treatment of TB?

Answer 19

As adjunctive therapy in patients with tuberculosis pericarditis
Meningeal tuberculosis

Question 20

What are the proposed mechanisms of infection in the fetus in TB ?

Answer 20

1- fetal ingestion of infected fluid
2- aspiration of the fluid
3- hematogenous infection via umbilical vein