Perspectives on tuberculosis in pregnancy
Perspectives on tuberculosis in pregnancy
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DOI：
10.1016/j.ijid.2014.12.014
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发表时间：
2015-03-01
影响因子：
8.4
通讯作者：
Zumla, Alimuddin
中科院分区：
文献类型：
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作者：
Bates, Matthew;Ahmed, Yusuf;Zumla, Alimuddin
近世纪来，结核病一直被认为是妊娠期发病和死亡的重要原因，但在艾滋病毒或其他贫困疾病高发人群等高危人群中开展全面结核病筛查和治疗的研究和努力，落后于解决妊娠期艾滋病毒感染和预防母婴传播的类似努力。怀孕期间的免疫变化使潜伏性结核感染或新发感染的激活比非怀孕妇女更有可能。妊娠期结核病治疗带来了一些研究不足的问题，例如抗结核病和抗艾滋病毒药物的禁忌症以及对新生儿的潜在风险，这些问题对于二线结核病治疗尤为重要。虽然先天性结核病被认为是罕见的，但来自艾滋病毒高负担环境的数据表明情况并非如此。需要进行更多的研究，筛查新生儿结核病，观察结果，并测试预防或治疗措施。国家结核病控制方案应与高负担人口的产前和国家艾滋病毒方案合作，在产前诊所提供筛查，或建立有效的系统，使高危孕妇能够前往常规结核病控制方案筛查站。(c)2014作者由爱思唯尔有限公司代表国际传染病学会出版。
Tuberculosis (TB) has been recognized as an important cause of morbidity and mortality in pregnancy for nearly a century, but research and efforts to roll out comprehensive TB screening and treatment in high-risk populations such as those with a high prevalence of HIV or other diseases of poverty, have lagged behind similar efforts to address HIV infection in pregnancy and the prevention of mother-to-child-transmission. Immunological changes during pregnancy make the activation of latent TB infection or de novo infection more likely than among non-pregnant women. TB treatment in pregnancy poses several problems that have been under-researched, such as contraindications to anti-TB and anti-HIV drugs and potential risks to the neonate, which are particularly important with respect to second-line TB treatment. Whilst congenital TB is thought to be rare, data from high HIV burden settings suggest this is not the case. There is a need for more studies screening for TB in neonates and observing outcomes, and testing preventative or curative actions. National tuberculosis control programmes (NTPs) should work with antenatal and national HIV programmes in high-burden populations to provide screening at antenatal clinics, or to establish functioning systems whereby pregnant women at high risk can drop in to routine NTP screening stations. (c) 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.