Pregnancy tuberculosis

Czeizel AE, Rockenbauer M, Olsen J, Sorensen HT A population-based case-control study of the safety of oral anti-tuberculosis drug treatment during pregnancy. Int J Tu-berc Lung Dis 2001 5 564-568. 

Hypertension during pregnancy, resolved postpartum Infectious diseases (HIV, schistosomiasis, tuberculosis, malaria)... 

Oral contraceptive tablets are used to prevent pregnancy. Isoniazid may be used to prevent the development of active tuberculosis in those individuals who have been exposed to the disease but show no evidence of infection, in those who test positively for it but have no apparent disease, and in those with once active but now inactive disease. 

Differential diagnosis Palmar erythema is also found in pregnancy, in hyperthyroidism, collagen diseases, endocarditis, long-standing feverish conditions, tuberculosis, diabetes mellitus, malignant tumours, chronic polyarthritis and in cases of malnutrition — as well as in healthy people. 

One girl in her third year, who had been immunized against tuberculosis at birth, developed an abscess of the associated lymph nodes (which were extirpated) and some weeks later developed intestinal BCG dissemination, which appeared to be cured by tuberculostatic treatment. Despite this, at the age of 22 years she developed a leftsided hemiplegia due to aneurysms and thrombosis of cerebral arteries, and 4 years later an oculomotor nerve paralysis was diagnosed. She died at 26 from recurrent intestinal BCG dissemination, which developed at the end of a pregnancy (a healthy premature child was bom). 

No harmful effects of BCG vaccine on the fetus have been seen. Nevertheless, it is prudent to avoid immunization of women during pregnancy, unless there is immediate excessive risk of unavoidable exposure to infective tuberculosis (97). 

Rifampicin is currently recommended by the WHO for the treatment of tuberculosis during pregnancy. On the other hand, drug companies advise against the use of rifampicin during the first 3 months of pregnancy, even though deleterious effects on the fetus have not been confirmed in man. 

Bothamley G. Drug treatment for tuberculosis during pregnancy safety considerations. Drug Saf 2001 24(7) 553-65. 

Vallejo JG, Starke JR. Tuberculosis and pregnancy. Clin Chest Med 1992 13 693-707. 

Folic acid deficiency can occur due to pregnancy, malabsorption syndromes or inadequate diet. Some drugs, for example phenytoin (used in epilepsy), oral contraceptives and isoniazid (used in treating tuberculosis), can cause reduced absorption of folic acid. Oral replacement therapy with folic acid is effective. 

Therapy for drug-sensitive pulmonary tuberculosis consists of isoniazid (5 mg/kg, up to 300 mg/day), rifampin (10 mg/tcg/day, up to 600 mg daily), pyrazinamide (15-30 mg/kg/day or a maximum of 2 g/day), and a fourth agent, typically either ethambutol (usual adult dose cf 15 mg/kg once per day) or streptomycin (1 g daily). The streptomycin dose is reduced to 1 g twice weekly after 2 months. Pyridoxine, 15-50 mg/day, also should be included for most adults to minimize adverse reactions to isoni(K,id. Isoniazid, rifampin, pyrazinamide, and ethambutol or streptomycin are given for 2 months isoniazid and rifampin are then continued for 4 more months. Doses in children are isoniazid, 10 mg/kg/day (300 mg maximum) rifampin, 10-20 mg/kg/day (600 mg maximum) pyrazinamide, 15-30 mg/kg/day (2 g maximum). Isoniazid, rifampin, and ethambutol are considered safe during pregnancy. 

Other Diseases. These included diabetes, scarlet fever, diphtheria, influenza, pulmonary tuberculosis, heart diseases (palpitation, edema, intermittency of pulse), disorders of respiration, asthma, hay fever, bronchitis, pneumonia, morning sickness during pregnancy, diarrhea, chronic gastritis, chronic rheumatism, eye inflammation, scrofula, leukemia, breast and other cancers, high blood pressure, bites of snakes and rabid animals, passive dropsies, as an abortifacient, and so on and so on. 

Pelvic inflammatory disease (PID) refers to an acute infection of the upper genital tract in women in the reproductive age, involving the uterus, fallopian tubes, and ovaries. Per definition, PID should be distinguished from pelvic infections caused by medical procedures, pregnancy, and other primary abdominal processes. PID usually results from sexually transmitted ascending infections typically by Neisseria gonorrhoeae or Chlamydia trachomatis, although 30%-40% of cases are polymicrobial. Actinomyces and tuberculosis account for rare causes of PID and may cause tubo-... 

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