Pregnancy-Related Tuberculous Meningitis and Immune Reconstitution Inflammatory Syndrome: A Case Series and Systematic Review.
Pregnancy-Related Tuberculous Meningitis and Immune Reconstitution Inflammatory Syndrome: A Case Series and Systematic Review.
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DOI：
10.1093/ofid/ofac513
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发表时间：
2022-10
影响因子：
4.2
通讯作者：
Bahr, Nathan C.
中科院分区：
文献类型：
--
作者：
Pastick, Katelyn A.;Kagimu, Enock;Dobbin, Joanna;Ssebambulidde, Kenneth;Gakuru, Jane;Milln, Jack;Nakabuye, Betty;Meya, David B.;Boulware, David R.;Cresswell, Fiona, V;Bahr, Nathan C.
结核病是育龄妇女死亡的主要原因。然而，结核脑膜炎是最严重的肺外结核病形式，在妊娠期很少被讨论，尽管这是一个独特的免疫调节期，可能使妇女更容易患上活动性疾病。我们确定并描述了2018年至2022年在乌干达进行脑膜炎临床试验期间筛查的孕妇或产后妇女中的结核性脑膜炎病例。我们通过PubMed/Medline和Embase对1970年至2022年7月10日的所有英文出版物进行了系统的文献综述，以确定更多的病例。我们在携带人类免疫缺陷病毒(HIV)的乌干达妇女中发现了8例与妊娠相关的结核性脑膜炎，并通过系统的文献回顾确定了另外40例(无HIV阳性)。在所有合并病例中，50%(24/48)被诊断为产后，50%(24/48)在妊娠期间起病，其中38%(9/24)在终止妊娠后症状加重或疾病复发。33%(16/48)的病例漏诊或延误诊断。在已知结局的患者中，产妇死亡率为23%(11/48)，胎儿/新生儿死亡率为30%(13/44)。在母体幸存者中，30%(11/37)有残留的神经功能缺陷。妊娠期或产后期结核性脑膜炎的真实发病率尚不清楚，但可能被低估了。到目前为止，几乎所有公布的病例都发生在艾滋病毒阴性或具有其他免疫能力的妇女身上。鉴于怀孕期间的生理性免疫抑制和随后的产后重建，医生必须意识到结核病脑膜炎和与妊娠相关的免疫重建炎症综合征，特别是在结核病负担较重的国家和感染艾滋病毒的妇女。结核病是育龄妇女死亡的主要原因，但与妊娠相关的结核性脑膜炎很少被讨论。我们分享了妊娠相关结核脑膜炎的病例系列和系统性综述的结果，以及与艾滋病毒携带者和非携带者的妇女相关的免疫重建。
Tuberculosis is a leading cause of death among women of reproductive age. However, tuberculous meningitis, the most severe form of extrapulmonary tuberculosis, is rarely discussed in pregnancy despite this being a unique period of immune modulation that may predispose women to active disease. We identified and described cases of tuberculous meningitis among pregnant or postpartum women screened during meningitis clinical trials in Uganda from 2018 to 2022. We conducted a systematic literature review via PubMed/Medline and Embase for all English-language publications from 1970 to 10 July 2022, to identify additional cases. We identified 8 cases of pregnancy-related tuberculous meningitis in Ugandan women living with human immunodeficiency virus (HIV) and 40 additional cases via systematic literature review (none HIV-positive). Of all combined cases, 50% (24/48) were diagnosed postpartum; 50% (24/48) had initial onset during pregnancy, of which 38% (9/24) had worsening of symptoms or disease relapse following pregnancy cessation. Diagnosis was missed or delayed in 33% (16/48) of cases. For those with known outcomes, maternal mortality was 23% (11/48) and fetal/neonatal mortality was 30% (13/44). Of maternal survivors, 30% (11/37) had residual neurologic deficits. The true incidence of tuberculous meningitis in pregnancy or the postpartum period is unclear but likely underappreciated. To date, nearly all published cases have occurred in HIV-negative or otherwise immunocompetent women. Given the well-described physiological immunosuppression during pregnancy and subsequent reconstitution postpartum, physicians must be aware of tuberculous meningitis and pregnancy-related immune reconstitution inflammatory syndrome, especially in countries with a high burden of tuberculosis and in women living with HIV. Tuberculosis is a leading cause of death among reproductive-age women, yet pregnancy-related tuberculous meningitis is seldom discussed. We share findings of a case series and systematic review of pregnancy-related tuberculous meningitis and associated immune reconstitution in women living with/without HIV.
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DOI：
10.1093/cid/ciab162
发表时间：
2021-09-07
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Cresswell FV;Meya DB;Kagimu E;Grint D;Te Brake L;Kasibante J;Martyn E;Rutakingirwa M;Quinn CM;Okirwoth M;Tugume L;Ssembambulidde K;Musubire AK;Bangdiwala AS;Buzibye A;Muzoora C;Svensson EM;Aarnoutse R;Boulware DR;Elliott AM
通讯作者：
Elliott AM
影响因子：
1.5
作者：
Baidya, D. K.;Trikha, A.;Garg, R.
通讯作者：
Garg, R.
DOI：
10.1056/nejmoa1013911
发表时间：
2011-10-20
期刊：
The New England journal of medicine
影响因子：
--
作者：
Blanc FX;Sok T;Laureillard D;Borand L;Rekacewicz C;Nerrienet E;Madec Y;Marcy O;Chan S;Prak N;Kim C;Lak KK;Hak C;Dim B;Sin CI;Sun S;Guillard B;Sar B;Vong S;Fernandez M;Fox L;Delfraissy JF;Goldfeld AE;CAMELIA (ANRS 1295–CIPRA KH001) Study Team
通讯作者：
CAMELIA (ANRS 1295–CIPRA KH001) Study Team
影响因子：
1.2
作者：
Ejiji, Isa Samson;Gomerep, Simji;Bemgba, Achie Basil
通讯作者：
Bemgba, Achie Basil
影响因子：
4.2
作者：
Ellis, Jayne;Bangdiwala, Ananta S.;Boulware, David R.
通讯作者：
Boulware, David R.