| losis (TB) is the number one infections disease killer | | | | New York to Los Angeles). The chest radiograph |
| worldwide. The World Health Care Organization | | | | should not be delayed during the first 3 months of |
| estimates that 2 billion people have latent TB, while | | | | pregnancy if the patient has symptoms.o Treatment |
| another 3 million people worldwide die each year due | | | | for active TB should be initiated even during the first |
| to TB. | | | | 3 months of pregnancy. INH, rifampin, and ethambutol |
| On average, the isoniazid (INH) resistance rate is | | | | may be used. Pyrazinamide should be used only in |
| approximately 10% and the rifampin resistance rate is | | | | women infected with HIV who are suspected of |
| approximately 1%, with lower numbers in countries | | | | having MDR-TB.o In most pregnant women, |
| with good TB programs and higher numbers in the | | | | preventive treatment should be delayed until 2-3 |
| countries with poor TB programs. | | | | months after delivery, even through no harmful |
| Humans are the only known reservoir for | | | | effects of INH on the fetus have been documented. |
| Mycobacterium tuberculosis. TB is transmitted by | | | | Consider preventive treatment during pregnancy in |
| airborne droplet nuclei, which may contain fewer than | | | | the following situations. |
| 10 bacilli. Exposure to TB occurs by sharing common | | | | " Pregnant women with a positive tuberculin skin test |
| airspace with a patient who is infectious. When | | | | who are HIV seropositive or who have behavioral |
| inhaled, droplet nuclei are deposited within the | | | | risk factors for HIV infection but decline HIV testing. |
| terminal airspaces of the lung. Upon encountering the | | | | " Pregnant women with a positive tuberculin skin test |
| bacilli, macrophages ingest and transport the bacteria | | | | who have in close contact with a patient who is |
| to regional lymph nodes. | | | | smear-positive for pulmonary TB. |
| Special Concerns: | | | | " Pregnant women who have had a documented |
| " Pregnancyo Pregnancy provides an opportunity to | | | | tuberculin skin test conversion in the past 2 years.o |
| screen for TB; all pregnant mothers can have | | | | To reduce the risk of peripartum hepatitis, |
| tuberculin skin testing performed. If skin testing | | | | preventive treatment should not be given for the |
| results are positive, a chest radiograph can be | | | | intial 2-3 months after delivery. Breastfeeding can be |
| obtained with lead shielding (the amount of radiation | | | | continued while on preventive therapy. Whether the |
| exposure of a single chest radiograph has been | | | | breastfeed infant should receive pyridoxine is |
| compared to that incurred on a regular flight from | | | | controversial. |