Document Type : Review articles
Authors
1 Scientific Affairs-University Headquarter, University of Anbar, Anbar, Iraq.
2 Anbar Education Directorate, Al-Anbar Secondary School for Distinguished Boys, Anbar, Iraq.
Abstract
Tuberculosis (TB) has been a well-known infectious disease for many centuries. It carries a high rate of morbidity and mortality across the globe. Pregnant women are more susceptible to TB than other individuals owing to the certain physiological changes that accompany pregnancy. There is still doubt that pregnancy is a risk factor for the progression of a TB infection (TBI) to a TB illness. Latent TB infection (LTBI), a term used to describe the fact that mycobacterium tuberculosis is found in a dormant stage, can be isolated in pregnant women. As a rule of thumb, early diagnosis and prompt treatment prevent unwanted complications and even mortality in pregnant women and developing fetuses. As a consequence, knowing the various aspects of TB is of utmost importance when dealing with physicians and pregnant women. Many diagnostic tools, including history and physical examination, chest X-ray, tuberculin test, and interferon-gamma release assays, are useful in the early detection of TB. However, the risks and benefits of each test should be taken into consideration. Furthermore, close monitoring of the pregnant woman with TB is an essential step for early detection of its complications. Anti-tuberculosis therapy, including isoniazid, rifampin, ethambutol, and pyrazinamide, can be used with certain modifications of their doses to decrease the risk of the disease to both a pregnant woman and her fetus. This narrative review aims to summarize the different aspects (epidemiological distribution, risk factors, diagnostic tools, complications, and management) of TB during pregnancy.
Keywords
- Tuberculosis disease
- Latent tuberculosis infection
- Mycobacterium tuberculosis
- Interferon gamma
- Pregnant women
Main Subjects
[1] F. A. H. Mejbel, I. A. J. Aljanaby, and A. A. J. Aljanaby, “Pulmonary tuberculosis risks and challenges,” in E3S Web of Conferences, 2023, vol. 381.
[2] R. M. Al-Ani, “Nasal Tuberculosis in a Teenage Female,” Indian J. Otolaryngol. Head Neck Surg., vol. 71, no. 3, pp. 2047–2049, 2019.
[3] A. DeLuca, R. E. Chaisson, and N. A. Martinson, “Intensified case finding for tuberculosis in prevention of mother to child transmission programs; a simple and potentially vital addition for maternal and child health,” J. Acquir. Immune Defic. Syndr., vol. 50, no. 2, p. 196, 2009.
[4] H. A. Awan et al., “Tuberculosis amidst COVID-19 in Pakistan: a massive threat of overlapping crises for the fragile healthcare systems,” Epidemiol. Infect., vol. 150, p. e41, 2022.
[5] A. A. J. Aljanaby, Q. M. H. Al-Faham, I. A. J. Aljanaby, and T. H. Hasan, “Epidemiological study of mycobacterium tuberculosis in Baghdad governorate, Iraq,” Gene Reports, vol. 26, p. 101467, 2022.
[6] I. Malhame, M. Cormier, J. Sugarman, and K. Schwartzman, “Latent tuberculosis in pregnancy: a systematic review,” PLoS One, vol. 11, no. 5, p. e0154825, 2016.
[7] K. Miele, S. B. Morris, and N. K. Tepper, “Tuberculosis in pregnancy,” Obstet. Gynecol., vol. 135, no. 6, p. 1444, 2020.
[8] J. S. Mathad and A. Gupta, “Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps,” Clin. Infect. Dis., vol. 55, no. 11, pp. 1532–1549, 2012.
[9] F. G. Sheriff et al., “Latent tuberculosis among pregnant mothers in a resource poor setting in Northern Tanzania: a cross-sectional study,” BMC Infect. Dis., vol. 10, no. 1, pp. 1–7, 2010.
[10] N. Salazar-Austin et al., “Poor obstetric and infant outcomes in human immunodeficiency virus-infected pregnant women with tuberculosis in South Africa: the Tshepiso study,” Clin. Infect. Dis., vol. 66, no. 6, pp. 921–929, 2018.
[11] J. S. Mathad, S. Yadav, A. Vaidyanathan, A. Gupta, and S. M. LaCourse, “Tuberculosis Infection in Pregnant People: Current Practices and Research Priorities,” Pathogens, vol. 11, no. 12, p. 1481, 2022.
[12] E. Vynnycky and P. E. M. Fine, “Lifetime risks, incubation period, and serial interval of tuberculosis,” Am. J. Epidemiol., vol. 152, no. 3, pp. 247–263, 2000.
[13] M. A. Huaman, G. S. Deepe Jr, and C. J. Fichtenbaum, “Elevated circulating concentrations of interferon-gamma in latent tuberculosis infection,” Pathog. Immun., vol. 1, no. 2, p. 291, 2016.
[14] S. Naik et al., “Systemic inflammation in pregnant women with latent tuberculosis infection,” Front. Immunol., vol. 11, p. 587617, 2021.
[15] D. Zenner, M. E. Kruijshaar, N. Andrews, and I. Abubakar, “Risk of tuberculosis in pregnancy: a national, primary care–based cohort and self-controlled case series study,” Am. J. Respir. Crit. Care Med., vol. 185, no. 7, pp. 779–784, 2012.
[16] N. Schwartz, S. A. Wagner, S. M. Keeler, J. Mierlak, D. E. Seubert, and A. B. Caughey, “Universal tuberculosis screening in pregnancy,” Am. J. Perinatol., pp. 447–451, 2009.
[17] A. Mahendru, K. Gajjar, and J. Eddy, “Diagnosis and management of tuberculosis in pregnancy,” Obstet. Gynaecol., vol. 12, no. 3, pp. 163–171, 2010.
[18] D. C. Ogbuabor and O. E. Onwujekwe, “Governance of tuberculosis control programme in Nigeria,” Infect. Dis. poverty, vol. 8, pp. 1–11, 2019.
[19] M. P. Golden and H. R. Vikram, “Extrapulmonary tuberculosis: an overview,” Am. Fam. Physician, vol. 72, no. 9, pp. 1761–1768, 2005.
[20] A. F. Al-Missadi et al., “Risk Factors of TB in Southern Iraq with Specific Focus on Governorates with Marshland Populations.,” Indian J. Public Heal. Res. Dev., vol. 11, no. 3, 2020.
[21] S. Abbasi, “Risk factors of tuberculosis in children,” Ann. Pak. Inst. Med. Sci, vol. 6, no. 1, pp. 50–54, 2010.
[22] R. S. Bedi, “Millary Tuberculosis during Corticosteroid Therapy,” Indian J. Tuberc., vol. 44, pp. 91–92, 1997.
[23] P. V. M. Lakshmi, N. K. Virdi, J. S. Thakur, K. R. Smith, M. N. Bates, and R. Kumar, “Biomass fuel and risk of tuberculosis: a case–control study from Northern India,” J Epidemiol Community Heal., vol. 66, no. 5, pp. 457–461, 2012.
[24] A. J. Al-Yasiri and I. J. Al-Yasiri, “Iraq’s Unemployment Realities and Causes: An Analytical Study,” Akkad J. Contemp. Econ. Stud., vol. 1, no. 1, pp. 17–28, 2021.
[25] T. Bjerkedal, S. L. Bahna, and E. H. Lehmann, “Course and outcome of pregnancy in women with pulmonary tuberculosis.,” Scand. J. Respir. Dis., vol. 56, no. 5, pp. 245–250, 1975.
[26] E. A. Wilson, T. J. Thelin, and P. V Dilts, “Tuberculosis complicated by pregnancy,” Am. J. Obstet. Gynecol., vol. 115, no. 4, pp. 526–529, 1973.
[27] C. J. Hoffmann et al., “High prevalence of pulmonary tuberculosis but low sensitivity of symptom screening among HIV-infected pregnant women in South Africa,” PLoS One, vol. 8, no. 4, p. e62211, 2013.
[28] M. A. Hamadeh and J. Glassroth, “Tuberculosis and pregnancy,” Chest, vol. 101, no. 4, pp. 1114–1120, 1992.
[29] M. A. Behr, E. Kaufmann, J. Duffin, P. H. Edelstein, and L. Ramakrishnan, “Latent tuberculosis: two centuries of confusion,” Am. J. Respir. Crit. Care Med., vol. 204, no. 2, pp. 142–148, 2021.
[30] D. L. Cohn, “Treatment of latent tuberculosis infection.,” in Seminars in respiratory infections, 2003, vol. 18, no. 4, pp. 249–262.
[31] T. D. Jackson and A. P. Murtha, “Anergy during pregnancy,” Am. J. Obstet. Gynecol., vol. 184, no. 6, pp. 1090–1092, 2001.
[32] J. Y. Lee et al., “Comparison of two commercial interferon-γ assays for diagnosing Mycobacterium tuberculosis infection,” Eur. Respir. J., vol. 28, no. 1, pp. 24–30, 2006.
[33] A. Weinberg et al., “Effects of pregnancy and isoniazid preventive therapy on Mycobacterium tuberculosis interferon gamma response assays in women with HIV,” Clin. Infect. Dis., vol. 73, no. 9, pp. e3555–e3562, 2021.
[34] G. Fröberg et al., “Screening and treatment of tuberculosis among pregnant women in Stockholm, Sweden, 2016–2017,” Eur. Respir. J., vol. 55, no. 3, 2020.
[35] J. S. Mathad et al., “Quantitative IFN-γ and IL-2 response associated with latent tuberculosis test discordance in HIV-infected pregnant women,” Am. J. Respir. Crit. Care Med., vol. 193, no. 12, pp. 1421–1428, 2016.
[36] R. Bhosale et al., “Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis (MTB)-induced immune response: Findings from PRACHITi, a cohort study in Pune, India,” Int. J. Infect. Dis., vol. 112, pp. 205–211, 2021.
[37] C. G. Atyeo et al., “Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms,” Nat. Commun., vol. 13, no. 1, p. 3571, 2022.
[38] A. O’Garra, P. S. Redford, F. W. McNab, C. I. Bloom, R. J. Wilkinson, and M. P. R. Berry, “The immune response in tuberculosis,” Annu. Rev. Immunol., vol. 31, pp. 475–527, 2013.
[39] J. M. Cliff, S. H. E. Kaufmann, H. McShane, P. van Helden, and A. O’Garra, “The human immune response to tuberculosis and its treatment: a view from the blood,” Immunol. Rev., vol. 264, no. 1, pp. 88–102, 2015.
[40] J. M. Tufariello, J. Chan, and J. L. Flynn, “Latent tuberculosis: mechanisms of host and bacillus that contribute to persistent infection,” Lancet Infect. Dis., vol. 3, no. 9, pp. 578–590, 2003.
[41] S. LaVergne et al., “Impact of latent tuberculosis infection on neurocognitive functioning and inflammation in HIV-infected and Uninfected South Indians,” J. Acquir. Immune Defic. Syndr., vol. 84, no. 4, p. 430, 2020.
[42] M. A. Huaman et al., “The relationship between latent tuberculosis infection and acute myocardial infarction,” Clin. Infect. Dis., vol. 66, no. 6, pp. 886–892, 2018.
[43] J. Jonsson, S. Kühlmann-Berenzon, I. Berggren, and J. Bruchfeld, “Increased risk of active tuberculosis during pregnancy and postpartum: a register-based cohort study in Sweden,” Eur. Respir. J., vol. 55, no. 3, 2020.
[44] A. P. Kourtis, J. S. Read, and D. J. Jamieson, “Pregnancy and infection,” N. Engl. J. Med., vol. 370, no. 23, pp. 2211–2218, 2014.
[45] S. M. LaCourse et al., “Evaluation of the isoniazid preventive therapy care cascade among HIV-positive female sex workers in Mombasa, Kenya,” J. Acquir. Immune Defic. Syndr., vol. 76, no. 1, p. 74, 2017.
[46] A. Saha et al., “Mycobacterium tuberculosis-specific T-cell responses are impaired during late pregnancy with elevated biomarkers of tuberculosis risk postpartum,” J. Infect. Dis., vol. 225, no. 9, pp. 1663–1674, 2022.
[47] S. N. Tripathy and S. N. Tripathy, “Tuberculosis and pregnancy,” Int. J. Gynecol. Obstet., vol. 80, no. 3, pp. 247–253, 2003.
[48] F. P. McCarthy, S. Rowlands, and M. Giles, “Tuberculosis in pregnancy–case studies and a review of Australia’s screening process,” Aust. New Zeal. J. Obstet. Gynaecol., vol. 46, no. 5, pp. 451–455, 2006.
[49] N. Jana, K. Vasishta, S. K. Jindal, B. Khunnu, and K. Ghosh, “Perinatal outcome in pregnancies complicated by pulmonary tuberculosis,” Int. J. Gynecol. Obstet., vol. 44, no. 2, pp. 119–124, 1994.
[50] G. Sotgiu, R. Centis, L. D’ambrosio, and G. B. Migliori, “Tuberculosis treatment and drug regimens,” Cold Spring Harb. Perspect. Med., vol. 5, no. 5, 2015.
[51] R. Figueroa-Damian and J. L. Arredondo-Garcia, “Pregnancy and tuberculosis: influence of treatment on perinatal outcome,” Am. J. Perinatol., vol. 15, no. 05, pp. 303–306, 1998.
[52] N. Jana, K. Vasishta, S. C. Saha, and K. Ghosh, “Obstetrical outcomes among women with extrapulmonary tuberculosis,” N. Engl. J. Med., vol. 341, no. 9, pp. 645–649, 1999.
[53] P. Nahid et al., “Official American thoracic society/centers for disease control and prevention/infectious diseases society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis,” Clin. Infect. Dis., vol. 63, no. 7, pp. e147–e195, 2016.
[54] D. M. Lewinsohn et al., “Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children,” Clin. Infect. Dis., vol. 64, no. 2, pp. e1–e33, 2017.
[55] P. Ormerod, “Tuberculosis in pregnancy and the puerperium,” Thorax, vol. 56, no. 6, pp. 494–499, 2001.
[56] A. Pawlowski, M. Jansson, M. Sköld, M. E. Rottenberg, and G. Källenius, “Tuberculosis and HIV co-infection,” PLoS Pathog., vol. 8, no. 2, p. e1002464, 2012.
[57] D. Salisbury, M. Ramsay, and K. Noakes, Immunisation against infectious diseases. The Stationery Office, 2006.
[58] A. C. Hesseling, M. F. Cotton, C. Fordham von Reyn, S. M. Graham, R. P. Gie, and G. D. Hussey, “Consensus statement on the revised World Health Organization recommendations for BCG vaccination in HIV-infected infants: Submitted on behalf of the BCG Working Group, Child Lung Health Section, International Union Against Tuberculosis and Lung Disease, 38th Union World Conference on Lung Health, Cape Town, 8–12 November 2007 [Official statement],” Int. J. Tuberc. lung Dis., vol. 12, no. 12, pp. 1376–1379, 2008.
[59] D. J. Barbeau et al., “Comparative analysis of human immune responses following SARS-CoV-2 vaccination with BNT162b2, mRNA-1273, or Ad26. COV2. S,” npj Vaccines, vol. 7, no. 1, p. 77, 2022.
[60] H. A. Alkayssi, “Ventilator-associated Pneumonia: A Narrative Review,” Al-Anbar Med. J., vol. 18, no. 2, pp. 56–60, 2022.
[61] F. Bongomin et al., “Latent tuberculosis infection status of pregnant women in Uganda determined using QuantiFERON TB Gold-Plus,” in Open forum infectious diseases, 2021, vol. 8, no. 6, p. ofab241.
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