Transcript Cytomegalovirus Infection and Pregnancy

Tuberculosis in Pregnancy
Max Brinsmead MB BS PhD
May 2015
Incidence
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In 1990 there were 6.6 million cases of TB
worldwide
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By 2008 this had risen to 9.4 million
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30% of those will be in women
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And 30% of these will be women of child-bearing age
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Pregnancy per se does NOT increase the risk of
TB infection
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Concomitant HIV infection is the biggest problem
Diagnosis
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Can be quite difficult when symptoms are
nonspecific
And resources are limited
Symptoms of ...
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Investigate by sputum exam for AFB
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Malaise
Fatigue
Weight loss
Cough & haemoptysis
Scrofula
Ascites
CXR can be negative in ≈1:6 cases pulmonary TB
Newer tests such as the Quanti-FERON-TB gold
in tube test promising
Effect of TB on Pregnancy
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If adequately treated the prognosis is good and
TB per se should not affect outcome
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But poor obstetric outcomes are common when
socio economic circumstances are taken into
account
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Especially when there is concomitant HIV
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There is a risk of mother to child transmission
Mother to Child Transmission of TB
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Can occur...
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In utero – transplacental
During labour – ingestion
From breast feeding with TB breast abscess
But most occurs by direct exposure to aerosol droplets
during postnatal contact
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Newly diagnosed and incompletely treated
mothers should be separated from their infants
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And all infants should receive prophylactic
Isoniazid
Treatment of Mothers with TB
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Should be the same as for non-pregnant ♀
But try to avoid Streptomycin
2 months of ...
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Ethambutal
Isoniazid
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Isoniazid plus Rifampicin
Compliance is a problem
Drug resistance is a problem
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Rifampicin
Pyrazinamide
Follow by 4 months of...
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Monitor liver function tests
And the safety of 2nd line therapy in pregnancy is unknown
If there is concomitant HIV try to treat that first if
possible
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Be aware that drug interactions with HAART occur
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