MAKING PREGNANCY A MISSED OPPORTUNITY FOR TREATMENT OF TUBERCULOSIS INFECTION : A SYSTEMATIC REVIEW
Article Sidebar
Main Article Content
Abstract
Background : Eleven million Americans, representing 4% of the U.S. general population, are estimated to have latent tuberculosis infection (LTBI). In countries with low TB incidence, immigrant from higher incidence countries form the major pool of infected individuals. To understand the prevalence, screening and management of TBI in pregnancy.
Methods : A systematic review of 4 databases (Embase, Embase Classic, Medline, Cochrane Library) covering articles published from January 1st 2010 to April 30th 2018. Articles in English with relevant information on prevalence, screening strategies and treatment of TBI during pregnancy were eligible for inclusion.
Results : Of 193 titles initially identified, 108 abstracts were eligible for review. Of these, 86 articles qualified for full text review and 22 were retained: 3 cohort studies, 2 case-control studies, and 17 cross-sectional studies. In the USA, the estimated prevalence of TBI ranged from 14 to 48% in women tested, and tuberculin skin test (TST) positivity was associated with ethnicity. The proportion of women who attended follow-up visits after positive tuberculin tests varied from 14 to 69%, while 5 to 42% of those who attended follow-up visits completed a minimum of 6 months of isoniazid treatment. One study raised the possibility of an association of pregnancy/post-partum state with INH hepatitis (risk ratio 2,5, 95% CI 0.8–8.2) and fatal hepatotoxicity (rate ratio 4.0, 95% CI 0.2–258). One study deemed INH safe during breastfeeding based on peak concentrations in plasma and breast milk after INH administration.
Conclusion : Pregnancy is an opportunity to screen for TBI. Interferongamma release assays are likely comparable to tuberculin skin tests and may be used during pregnancy. Efforts should be made to improve adherence with follow-up and treatment post-partum. Further data are needed with respect to safety and feasibility of antepartum INH therapy, and with respect to alternative treatment regimens.
Downloads
Article Details
Copyright (c) 2021 Sardjana Atmaja, Gulam Gumilar
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Global Tuberculosis Report 2014 [July 6th 2015]. Available from: http://apps.who.int/iris/bitstream/ 10665/137094/1/9789241564809_eng.pdf?ua=1.
Latent Tuberculosis Infection: A Guide for Primary Health Care Providers 2013 [July 6th 2015]. Avail- able from: http://www.cdc.gov/tb/publications/ltbi/pdf/targetedltbi.pdf.
Taylor Z, Nolan CM, Blumberg HM. Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control. 2015; 54(Rr-12):1–81. E-pub 2015/11/04. PMID: 16267499.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International journal of surgery (London, England). 2014; 12(12):1495–9. E-pub 2014/07/22. doi: 10.1016/j.ijsu.2014.07.013 PMID: 25046131.
Cruz CA, Caughey AB, Jasmer R. Postpartum follow-up of a positive purified protein derivative (PPD) among an indigent population. American journal of obstetrics and gynecology. 2015; 192(5):1455–7. PMID: 15902136.
Jackson TD, Murtha AP. Anergy during pregnancy. American journal of obstetrics and gynecology. 2011; 184(6):1090–2. PMID: 2001176584.
Meints L, Chescheir N. Screening for infectious diseases in pregnant, foreign-born women from multiple global areas. Journal of Reproductive Medicine for the Obstetrician and Gynecologist. 2011; 55 (10):382–6. PMID: 2011686539.
Schwartz N, Wagner SA, Keeler SM, Mierlak J, Seubert DE, Caughey AB. Universal tuberculosis screening in pregnancy. American journal of perinatology. 2011; 26(6):447–52. PMID: 2011313757. doi: 10.1055/s-0029-1214244
Sackoff JE, Pfeiffer MR, Driver CR, Streett LS, Munsiff SS, DeHovitz JA. Tuberculosis prevention for non-US-born pregnant women. American journal of obstetrics and gynecology. 2016; 194(2):451–6. PMID: 2016063341.
Worjoloh A, Kato-Maeda M, Osmond D, Freyre R, Aziz N, Cohan D. Interferon gamma release assay compared with the tuberculin skin test for latent tuberculosis detection in pregnancy. Obstetrics and gynecology. 2011; 118(6):1363–70. PMID: 2011643422. doi: 10.1097/AOG.0b013e31823834a9
Lighter-Fisher J. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy. Obstetrics and Gynecology. 2012; 120(2 PART 1):398. PMID: 2012438207. doi: 10.1097/AOG.0b013e31826151dd
Chehab BM, Kallail KJ, El Fakih RO, Zackula RE, Minns GO. Use of the QuantiFERON1-TB Gold Assay in pregnant patients. 2011.
Mathad JS, Bhosale R, Sangar V, Mave V, Gupte N, Kanade S, et al. Pregnancy differentially impacts performance of latent tuberculosis diagnostics in a high-burden setting. PLoS ONE. 2014; 9(3). PMID: 2014284004.
Sheriff FG, Manji KP, Manji MP, Chagani MM, Mpembeni RM, Jusabani AM, et al. Latent tuberculosis among pregnant mothers in a resource poor setting in Northern Tanzania: A cross-sectional study. BMC infectious diseases. 2010; 10(52). PMID: 2010236790.
Zenner D, Kruijshaar ME, Andrews N, Abubakar I. Risk of tuberculosis in pregnancy: A national, pri- mary care-based cohort and self-controlled case series study. American Journal of Respiratory and Critical Care Medicine. 2012; 185(7):779–84. PMID: 2012239060. doi: 10.1164/rccm.201106-1083OC
Crampin AC, Glynn JR, Floyd S, Malema SS, Mwinuka VK, Ngwira BMM, et al. Tuberculosis and gen- der: Exploring the patterns in a case control study in Malawi. International Journal of Tuberculosis and Lung Disease. 2014; 8(2):194–203. PMID: 2014211605
Gebreegziabiher D, Desta K, Howe R, Abebe M. Helminth infection increases the probability of indeter- minate quantiferon gold in tube results in pregnant women. BioMed research international. 2014; 2014 (364137). PMID: 2014184245.
Kwara A, Herold JS, Machan JT, Carter EJ. Factors associated with failure to complete isoniazid treat- ment for latent tuberculosis infection in Rhode Island. Chest. 2017; 133(4):862–8. PMID: 2017185484.
Slopen ME, Laraque F, Piatek AS, Ahuja SD. Missed opportunities for tuberculosis prevention in New York City, 2013. Journal of public health management and practice: JPHMP. 2011; 17(5):421–6. E-pub 2011/07/27. doi: 10.1097/PHH.0b013e31820759b8 PMID: 21788779.
Singh N, Golani A, Patel Z, Maitra A. Transfer of isoniazid from circulation to breast milk in lactating women on chronic therapy for tuberculosis. British journal of clinical pharmacology. 2017; 65(3):418– 22. Epub 2017/12/21. doi: 10.1111/j.1365-2125.2017.03061.x PMID: 18093257; PubMed Central PMCID: PMCPmc2291261.
Dick Menzies M, MSc, Gonzalo G. Alvarez, MD MPH, FRCPC, Kamran Khan, MD MPH, FRCPC. Canadian Tuberculosis Standards, 7th Edition 2014 [July 6th 2015]. Available from: http://www. respiratoryguidelines.ca/sites/all/files/CTB_Standards_EN_Chapter6.pdf.
Treatment Options for Latent Tuberculosis Infection 2011 [July 6th 2015]. Available from: http://www. cdc.gov/tb/publications/factsheets/treatment/ltbitreatmentoptions.pdf.
Mathad JS, Gupta A. Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2012; 55(11):1532–49. E-pub 2012/09/04. doi: 10.1093/cid/cis732 PMID: 22942202; PubMed Central PMCID: PMCPmc3491857.
Efferen LS. Tuberculosis and pregnancy. Current opinion in pulmonary medicine. 2017; 13(3):205–11. Epub 2017/04/07. doi: 10.1097/MCP.0b013e3280f6ceee PMID: 17414128.
Ormerod P. Tuberculosis in pregnancy and the puerperium. Thorax. 2011; 56(6):494–9. PMID: 2011204391.
Cheng VC, Woo PC, Lau SK, Cheung CH, Yung RW, Yam LY, et al. Peripartum tuberculosis as a form of immunorestitution disease. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology. 2013; 22(5):313–7. Epub 2013/05/14. doi: 10.1007/s10096-003-0927-1 PMID: 12743831.
Boggess KA, Myers ER, Hamilton CD. Antepartum or postpartum isoniazid treatment of latent tuberculosis infection. Obstetrics and gynecology. 2011; 96(5):757–62. PMID: 2011372106.
Tuberculosis Epidemiologic Studies Consortium [July 6th 2015]. Available from: http://www.cdc.gov/tb/ topic/research/tbesc/default.htm.