Features of chemoresistant tuberculosis/HIV co-infection in pregnant women (two case reports)
Background. These days throughout the world, the global issues are such diseases as chemoresistant tuberculosis (CRTB) and human immunodeficiency virus (HIV), which greatly complicate each other in combined course. At the same time, tuberculosis as an opportunistic disease is one of the main causes of death in HIVpositive patients. Having analyzed the literature data, we found that the course of pregnancy in patients with drugsusceptible tuberculosis/HIV coinfection is sufficiently covered today. However, there are only a few works that highlight this issue in patients with CRTB/HIV coinfection, which is characterized by a more complex course and complications. The purpose: to update the literature data with the clinical features of CRTB/HIV coinfection course in pregnant women based on case reports. Materials and methods. Two own clinical cases of CRTB/HIV coinfection course in pregnant women have been described. Patients were hospitalized to the department of pulmonary tuberculosis no. 3 (clinical site of phthisiology and pulmonology department of Zaporizhzhia State Medical University at the Municipal Institution “Zaporizhzhia Regional Tuberculosis Clinical Dispensary”). Results. In the first case, the severity of patient’s state and rapid disease progression were caused by tuberculosis process spreading due to severe immunodeficiency, which resulted in intrauterine fetal demise (32 weeks), multiple organ failure, intestinal perforation and peritonitis. In the second case, the patient did not adhere to treatment of both tuberculosis and HIV infection that was associated with a rapid progression of specific process reported to be lifethreatening and was the cause of elective abortion at 20 weeks of gestation. Conclusions. These clinical cases demonstrate the complexity and difficulties in management of CRTB/HIV coinfection in pregnant women due to nonadherence to treatment, rapid disease progression (tuberculosis process spreading, worsening of immunodeficiency) leading to the lifethreatening situation for mothers and increasing perinatal mortality rate.
Gaborec' TL. Peculiarities of the course of pregnancy in women with HIVassociated tuberculosis. Zdorov'e zhenshhiny. 2015; 1(97): 182–184. (In Ukrainian).
Jana N, Barik S, Arora N, Singh AK. Tuberculosis in pregnancy: The challenges for South Asian countrie. Journal of Obstetrics and Gynae-cology Research. 2012; 38(9): 1125–1136. doi: 10.1111/j.14470756.2012.01856.x.
Gupta A, Bhosale R, Kinikar A, Gupte N, Bharadwaj R, Kagal A et al. Maternal tuberculosis: a risk factor for mothertochild transmission of human immunodeficiecy virus. Journal of Infectious Diseases. 2011; 203: 358–362. doi: 10.1093/jinfdis/jiq064.
Mathad JS, Gupta A. Tuberculosis in Pregnant and Postpartum Women: Epidemiology, Management, and Research Gaps. Clin Infect Dis. 2012; 55(11): 1532–1549. doi: 10.1093/cid/cis732.
Nesterenko AV, Zimina VN, Brehova IS. A case of tuberculosis in an HIVinfected pregnant woman. Zhurnal infektologii. 2016; 8(2): 100–104. (In Russian).
Sobhy S, Babiker Z, Zamora J, Khan K, Kunst H. Maternal and perinatal mortality and morbidity associated with tuberculosis during preg-nancy and the postpartum period: a systematic review and metaanalysis. BJOG. 2017; 124(5): 727–733. doi: 10.1111/14710528.14408.
Khan M, Pillay T, Moodley J, Ramjee A, Padayatchi N. Pregnancies complicated by multidrugresistant tuberculosis and HIV coinfection in Durban, South Africa. The International Journal of Tuberculosis and Lung Disease. 2007; 11 (6): 706–708.
Nesterenko AV. Tuberculosis in pregnant women with different HIV status: features of the course and effectiveness of treatment: dissertation author's abstract for the degree of candidate of medical sciences. Moskva, 2018: 26. (In Russian).
Ukraina. MOZ. Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care for adults "Tuberculosis". Nakaz MOZ Ukrainy 620. 2014: 139. (In Ukrainian).
Copyright (c) 2019 ACTUAL INFECTOLOGY
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2020