Tuberculosis during pregnancy in northern Israel, 2002–2012: Epidemiology and clinical practices

Background: Atypical presentation of tuberculosis (TB) duringpregnancy may cause diagnostic delay and adversely influencepregnancy outcome.Objectives: To examine the incidence and clinical and epidemiologicalfeatures of TB during pregnancy and investigateinfection control measures at delivery and during the postpartumperiod.Methods: We retrospectively evaluated all reported cases ofTB diagnosed during pregnancy to 6 months postpartum inIsrael’s Northern Health District (2002–2012).Results: Active TB was detected in six patients; all werenegative for human immunodeficiency virus (HIV). Twopatients were diagnosed in the postpartum period, and fourhad pulmonary involvement. The average incidence duringthis period (39 per 100,000 pregnancies) was similar to thatin the general population. Five patients were at high risk ofcontracting TB due to either recent immigration from a highburdencountry or being in contact with another individualwith active TB. Patients with pleuropulmonary involvementhad prolonged cough and abnormal chest X-rays, withoutfever. Diagnosis was delayed for 3 to 7 months from symptomonset. Investigation of the newborn to rule out intrauterineinfection was conducted in only one of four relevant cases. Allpatients were infected with organisms susceptible to all firstlinedrugs, and all were cured with standard therapy.Conclusions: There was a considerable delay in the diagnosis ofTB among pregnant women, and investigation of the newbornupon delivery to rule out TB infection was routinely omitted.Effective management of TB during pregnancy and the postpartumperiod requires a multidisciplinary approach including anobstetrician, pediatrician, TB specialist, and public health physician.