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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(04): 358-365
DOI: 10.1055/a-0774-7924
GebFra Science
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Tuberculosis in Pregnancy – a Summary

Article in several languages: English | deutsch
Benjamin Wolf   *
1   Abteilung für Geburtsmedizin, Universitätsfrauenklinik Leipzig, Universitätsklinikum Leipzig AöR, Leipzig, Germany
,
Marco Krasselt   *
2   Sektion Rheumatologie, Klinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
,
Jonathan de Fallois
3   Interdisziplinäre Internistische Intensiveinheit, Universitätsklinikum Leipzig AöR, Leipzig, Germany
,
Amrei von Braun   **
4   Fachbereich Infektions- und Tropenmedizin, Klinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
,
Holger Stepan   **
1   Abteilung für Geburtsmedizin, Universitätsfrauenklinik Leipzig, Universitätsklinikum Leipzig AöR, Leipzig, Germany
› Author Affiliations
Further Information

Publication History

received 26 July 2018
revised 23 October 2018

accepted 23 October 2018

Publication Date:
08 January 2019 (online)

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Abstract

In recent years, the incidence of tuberculosis in pregnancy in the industrialised countries has increased. Tuberculosis in pregnancy is associated with an increased risk for the mother and child. Even if no figures are available for Germany, an increase in the number of tuberculosis cases among pregnant women can be assumed due to the migratory flows; current data from the USA, for example, also show an increasing incidence of tuberculosis in pregnant women in recent years. The physiological and immunological changes that occur during pregnancy are likely to have a negative impact on the course of the disease and may make it more difficult to confirm the diagnosis. There are no internationally standardised recommendations for diagnosing latent tuberculosis infections. When screening for TB is performed in specific risk populations, an Interferon-γ Release Assay (IGRA) should preferably be carried out according to the current study data. If corresponding symptoms are present and an IGRA test is positive, further diagnostics are indicated, also in pregnancy. If tuberculosis is confirmed, the fact that a woman is pregnant must not delay the initiation of anti-tuberculosis therapy, as an early start of therapy is associated with a more favourable outcome for both mother and child. The common first-line therapeutic drugs may also be used during pregnancy and are considered safe. The treatment of latent tuberculosis during pregnancy is disputed.

Key words

infections - pregnancy - tuberculosis - immunological changes - epidemiology - therapy

* BW and MK contributed in equal shares.


** AvB and HS contributed in equal shares.


 

  • References/Literatur

  • 1 WHO. Global Tuberculosis Report 2017. Geneva: World Health Organization. Online: http://apps.who.int/medicinedocs/documents/s23360en/s23360en.pdf last access: 20.12.2018
    PubMedGoogle Scholar
  • 2 Robert Koch-Institut. Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2016. Berlin: Robert Koch-Institut. Online: http://www.rki.de/tuberkulose last access: 20.12.2018
    PubMedGoogle Scholar
  • 3 Sugarman J, Colvin C, Moran AC. et al. Tuberculosis in pregnancy: an estimate of the global burden of disease. Lancet Glob Health 2014; 2: e710-e716
    CrossrefPubMedGoogle Scholar
  • 4 El-Messidi A, Czuzoj-Shulman N, Spence AR. et al. Medical and obstetric outcomes among pregnant women with tuberculosis: a population-based study of 7.8 million births. Am J Obstet Gynecol 2016; 215: 797.e1-797.e6
    CrossrefPubMedGoogle Scholar
  • 5 Getahun H, Gunneberg C, Granich R. et al. HIV infection-associated tuberculosis: the epidemiology and the response. Clin Infect Dis 2010; 50: S201-S207
    CrossrefPubMedGoogle Scholar
  • 6 Pazos M, Sperling RS, Moran TM. et al. The influence of pregnancy on systemic immunity. Immunol Res 2012; 54: 254-261
    CrossrefPubMedGoogle Scholar
  • 7 Robinson DP, Klein SL. Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm Behav 2012; 62: 263-271
    CrossrefPubMedGoogle Scholar
  • 8 Elenkov IJ, Wilder RL, Bakalov VK. et al. IL-12, TNF-alpha, and hormonal changes during late pregnancy and early postpartum: implications for autoimmune disease activity during these times. J Clin Endocrinol Metab 2001; 86: 4933-4938
    PubMedGoogle Scholar
  • 9 Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med 2014; 370: 2211-2218
    CrossrefPubMedGoogle Scholar
  • 10 Wegmann TG, Lin H, Guilbert L. et al. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon?. Immunol Today 1993; 14: 353-356
    CrossrefPubMedGoogle Scholar
  • 11 Bercovitch RS, Catanzaro A, Schwartz BS. et al. Coccidioidomycosis during pregnancy: a review and recommendations for management. Clin Infect Dis 2011; 53: 363-368
    CrossrefPubMedGoogle Scholar
  • 12 Meijer WJ, van Noortwijk AG, Bruinse HW. et al. Influenza virus infection in pregnancy: a review. Acta Obstet Gynecol Scand 2015; 94: 797-819
    CrossrefPubMedGoogle Scholar
  • 13 Neuzil KM, Reed GW, Mitchel EF. et al. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol 1998; 148: 1094-1102
    CrossrefPubMedGoogle Scholar
  • 14 Bothamley GH, Ehlers C, Salonka I. et al. Pregnancy in patients with tuberculosis: a TBNET cross-sectional survey. BMC Pregnancy Childbirth 2016; 16: 304
    CrossrefPubMedGoogle Scholar
  • 15 Krasselt M, Baerwald C. Sex, Symptom Severity, and Quality of Life in Rheumatology. Clin Rev Allergy Immunol 2017; DOI: 10.1007/s12016-017-8631-6.
    CrossrefPubMedGoogle Scholar
  • 16 Orme IM, Robinson RT, Cooper AM. The balance between protective and pathogenic immune responses in the TB-infected lung. Nat Immunol 2015; 16: 57-63
    CrossrefPubMedGoogle Scholar
  • 17 Dorhoi A, Kaufmann SH. Perspectives on host adaptation in response to Mycobacterium tuberculosis: modulation of inflammation. Semin Immunol 2014; 26: 533-542
    CrossrefPubMedGoogle Scholar
  • 18 Ramakrishnan L. Revisiting the role of the granuloma in tuberculosis. Nat Rev Immunol 2012; 12: 352-366
    CrossrefPubMedGoogle Scholar
  • 19 Dorhoi A, Kaufmann SH. Tumor necrosis factor alpha in mycobacterial infection. Semin Immunol 2014; 26: 203-209
    CrossrefPubMedGoogle Scholar
  • 20 Cantini F, Nannini C, Niccoli L. et al. Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice. Autoimmun Rev 2015; 14: 503-509
    CrossrefPubMedGoogle Scholar
  • 21 Singh N, Perfect JR. Immune reconstitution syndrome and exacerbation of infections after pregnancy. Clin Infect Dis 2007; 45: 1192-1199
    CrossrefPubMedGoogle Scholar
  • 22 Zenner D, Kruijshaar ME, Andrews N. et al. Risk of tuberculosis in pregnancy: a national, primary care-based cohort and self-controlled case series study. Am J Respir Crit Care Med 2012; 185: 779-784
    CrossrefPubMedGoogle Scholar
  • 23 Zumla A, Raviglione M, Hafner R. et al. Tuberculosis. N Engl J Med 2013; 368: 745-755
    CrossrefPubMedGoogle Scholar
  • 24 Knight M, Kurinczuk JJ, Nelson-Piercy C. et al. Tuberculosis in pregnancy in the UK. BJOG 2009; 116: 584-588
    CrossrefPubMedGoogle Scholar
  • 25 Llewelyn M, Cropley I, Wilkinson RJ. et al. Tuberculosis diagnosed during pregnancy: a prospective study from London. Thorax 2000; 55: 129-132
    CrossrefPubMedGoogle Scholar
  • 26 Kothari A, Mahadevan N, Girling J. Tuberculosis and pregnancy–Results of a study in a high prevalence area in London. Eur J Obstet Gynecol Reprod Biol 2006; 126: 48-55
    CrossrefPubMedGoogle Scholar
  • 27 Cheng VC, Woo PC, Lau SK. et al. Peripartum tuberculosis as a form of immunorestitution disease. Eur J Clin Microbiol Infect Dis 2003; 22: 313-317
    CrossrefPubMedGoogle Scholar
  • 28 Toppenberg KS, Hill DA, Miller DP. Safety of radiographic imaging during pregnancy. Am Fam Physician 1999; 59: 1813-1818 1820
    PubMedGoogle Scholar
  • 29 Seelbach-Göbel B, Beckmann MW. 240. Stellungnahme des DZK in Zusammenarbeit mit FZB, DGI, DGPI, GPP, DGGG, DRG und DGMP zum Tuberkulosescreening bei Schwangeren im Kontext von § 36 (4) Infektionsschutzgesetz (IfSG). Geburtsh Frauenheilk 2017; 77: 128-131 doi:10.1055/s-0042-123082
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Dheda K, Barry 3rd CE, Maartens G. Tuberculosis. Lancet 2016; 387: 1211-1226
    CrossrefPubMedGoogle Scholar
  • 31 WHO. Systematic Screening for Active Tuberculosis: Principles and Recommendations. Geneva: World Health Organization. Online: https://www.who.int/tb/tbscreening/en/ last access: 20.12.2018
    PubMedGoogle Scholar
  • 32 Li S, Liu B, Peng M. et al. Diagnostic accuracy of Xpert MTB/RIF for tuberculosis detection in different regions with different endemic burden: A systematic review and meta-analysis. PLoS One 2017; 12: e0180725
    CrossrefPubMedGoogle Scholar
  • 33 Figueroa-Damian R, Arredondo-Garcia JL. Pregnancy and tuberculosis: influence of treatment on perinatal outcome. Am J Perinatol 1998; 15: 303-306
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Ziegler R, Just HM, Castell S. et al. [Tuberculosis infection control–recommendations of the DZK]. Pneumologie 2012; 66: 269-282
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Schaberg T, Bauer T, Brinkmann F. et al. [Tuberculosis Guideline for Adults – Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie 2017; 71: 325-397
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Nahid P, Dorman SE, Alipanah N. 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 2016; 63: e147-e195
    CrossrefPubMedGoogle Scholar
  • 37 Nguyen HT, Pandolfini C, Chiodini P. et al. Tuberculosis care for pregnant women: a systematic review. BMC Infect Dis 2014; 14: 617
    CrossrefPubMedGoogle Scholar
  • 38 Sobhy S, Babiker Z, Zamora J. et al. Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis. BJOG 2017; 124: 727-733
    CrossrefPubMedGoogle Scholar
  • 39 Grange J, Adhikari M, Ahmed Y. et al. Tuberculosis in association with HIV/AIDS emerges as a major nonobstetric cause of maternal mortality in Sub-Saharan Africa. Int J Gynaecol Obstet 2010; 108: 181-183
    CrossrefPubMedGoogle Scholar
  • 40 Khan M, Pillay T, Moodley JM. et al. Maternal mortality associated with tuberculosis-HIV-1 co-infection in Durban, South Africa. AIDS 2001; 15: 1857-1863
    CrossrefPubMedGoogle Scholar
  • 41 Salazar-Austin N, Hoffmann J, Cohn S. 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 2018; 66: 921-929
    CrossrefPubMedGoogle Scholar
  • 42 Jana N, Vasishta K, Saha SC. et al. Obstetrical outcomes among women with extrapulmonary tuberculosis. N Engl J Med 1999; 341: 645-649
    CrossrefPubMedGoogle Scholar
  • 43 Peng W, Yang J, Liu E. Analysis of 170 cases of congenital TB reported in the literature between 1946 and 2009. Pediatr Pulmonol 2011; 46: 1215-1224
    CrossrefPubMedGoogle Scholar
  • 44 Hageman J, Shulman S, Schreiber M. et al. Congenital tuberculosis: critical reappraisal of clinical findings and diagnostic procedures. Pediatrics 1980; 66: 980-984
    PubMedGoogle Scholar
  • 45 Feiterna-Sperling C, Brinkmann F, Adamczick C. et al. [Consensus-Based Guidelines for Diagnosis, Prevention and Treatment of Tuberculosis in Children and Adolescents – A Guideline on Behalf of the German Society for Pediatric Infectious Diseases (DGPI)]. Pneumologie 2017; 71: 629-680
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Mathad JS, Bhosale R, Sangar V. et al. Pregnancy differentially impacts performance of latent tuberculosis diagnostics in a high-burden setting. PLoS One 2014; 9: e92308
    CrossrefPubMedGoogle Scholar
  • 47 Malhame I, Cormier M, Sugarman J. et al. Latent Tuberculosis in Pregnancy: A Systematic Review. PLoS One 2016; 11: e0154825
    CrossrefPubMedGoogle Scholar
  • 48 Lighter-Fisher J, Surette AM. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy. Obstet Gynecol 2012; 119: 1088-1095
    CrossrefPubMedGoogle Scholar
  • 49 Menzies D, Adjobimey M, Ruslami R. et al. Four Months of Rifampin or Nine Months of Isoniazid for Latent Tuberculosis in Adults. N Engl J Med 2018; 379: 440-453
    CrossrefPubMedGoogle Scholar
  • 50 WHO. Guidelines on the management of latent tuberculosis infection 2015. Geneva: World Health Organization. Online: https://www.who.int/tb/publications/ltbi_document_page/en/ last access: 20.12.2018
    PubMedGoogle Scholar
  • 51 Moro RN, Scott NA, Vernon A. et al. Exposure to Latent Tuberculosis Treatment during Pregnancy: The PREVENT TB and the iAdhere Trials. Ann Am Thorac Soc 2018; DOI: 10.1513/AnnalsATS.201704-326OC.
    CrossrefPubMedGoogle Scholar
  • 52 Sackoff JE, Pfeiffer MR, Driver CR. et al. Tuberculosis prevention for non-US-born pregnant women. Am J Obstet Gynecol 2006; 194: 451-456
    CrossrefPubMedGoogle Scholar
  • 53 Cruz CA, Caughey AB, Jasmer R. Postpartum follow-up of a positive purified protein derivative (PPD) among an indigent population. Am J Obstet Gynecol 2005; 192: 1455-1457
    CrossrefPubMedGoogle Scholar
  • 54 Kwara A, Herold JS, Machan JT. et al. Factors associated with failure to complete isoniazid treatment for latent tuberculosis infection in Rhode Island. Chest 2008; 133: 862-868
    CrossrefPubMedGoogle Scholar