Tuberculosis in pregnancy
- Lloyd N Friedman, MD
Lloyd N Friedman, MD
- Clinical Professor of Medicine, Yale University School of Medicine
- Chief Operating Officer and Vice President, Medical Affairs, Milford Hospital
- Lynn T Tanoue, MD
Lynn T Tanoue, MD
- Professor of Medicine
- Yale University School of Medicine
- Section Editors
- C Fordham von Reyn, MD
C Fordham von Reyn, MD
- Section Editor — Tuberculosis; Nontuberculous Mycobacterial Infections
- Professor of Medicine
- Geisel School of Medicine at Dartmouth
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Worldwide, the burden of tuberculosis (TB) disease in pregnant women is substantial. It was estimated that more than 200,000 cases of active tuberculosis occurred among pregnant women globally in 2011; the burden was greatest in Africa and Southeast Asia . In the United States between 2003 and 2011, the incidence of TB in pregnancy was 26.6 per 100,000 births . (See "Epidemiology of tuberculosis".)
Prenatal care presents a unique opportunity for evaluation and management of latent and active tuberculosis among individuals with risk of tuberculosis who may not otherwise present for medical care [3,4].
Issues related to diagnosis and treatment of latent TB infection and active TB disease in pregnant women will be reviewed here. Issues related to the management of latent and active TB in nonpregnant patients are discussed in detail separately, as are issues related to perinatal TB infection. (See "Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-uninfected adults" and "Diagnosis of pulmonary tuberculosis in HIV-uninfected patients" and "Tuberculosis disease in children", section on 'Perinatal infection'.)
NATURAL HISTORY OF TB IN PREGNANCY
Tuberculosis (TB) infection is caused by inhalation of viable bacilli, which may persist in an inactive state (known as latent TB infection [LTBI]) or progress to active TB disease.
Individuals with LTBI are asymptomatic and not contagious. Latent TB bacilli remain viable and may reactivate, causing active symptomatic TB disease, which can be transmitted via airborne spread.
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- NATURAL HISTORY OF TB IN PREGNANCY
- LATENT TUBERCULOSIS INFECTION IN PREGNANCY
- Screening for LTBI
- - Whom to test
- - How to test
- - Diagnostic evaluation after positive test
- Clinical manifestations
- - Whom to treat during pregnancy
- Selecting a treatment regimen
- - Whom to treat after delivery
- ACTIVE TUBERCULOSIS DISEASE IN PREGNANCY
- Clinical manifestations
- - Whom to treat
- - Selecting a treatment regimen
- Controlling transmission
- MONITORING DURING TREATMENT
- SUMMARY AND RECOMMENDATIONS
- General principles
- Latent tuberculosis
- Active tuberculosis
- Other principles