Laryngeal &amp;amp; Lower lung field tuberculosis in pregnancy: A case report

Patil, Shital; Mirza, Mazhar

doi:10.29333/ejgm/82343

Cited by 4 publications

(6 citation statements)

References 1 publication

(1 reference statement)

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“…Family planning counselling should be done at baseline, with information provided to women to include options for contraceptive methods depending on the TB or DR-TB regimen they may be on (such as rifampicin inclusive regimen), side effects they may experience on contraceptive of choice and how to switch method or discontinue method. Women should be offered a method which is the most effective, such as a long-acting reversible contraceptive (LARC), that does not interfere with either TB/DR-TB or HIV treatment and is well-suited for her lifestyle and belief.† 69 75 88 96 …”

Section: Discussionmentioning

confidence: 99%

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

et al. 2022

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Objectives(1) Summarise and evaluate the current evidence of tuberculosis (TB)-associated pregnancy outcomes, (2) evaluate the state of the science of family planning during TB treatment and (3) provide recommendations to move forward to improve care and outcomes during TB disease.DesignSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.Data sourcesPubMed, Embase, CINAHL, Cochrane, Web of Science and Scopus were searched from September 2009 to November 2021.Eligibility criteriaStudies were included if they assessed pregnant women with active TB, drug-resistant TB (DR-TB) or TB/HIV coinfection and examined pregnancy, maternal, fetal/birth and TB or TB/HIV coinfection outcomes. Studies were also included if they examined family planning services among women initiating TB treatment.Data extraction and synthesisTwo independent reviewers extracted data using PRISMA guidelines and conducted quality assessment using the Joanna-Briggs Institute Critical Appraisal Tools. The level of evidence was reported using the Johns Hopkins Evidence-Based Practice guidelines.Results69 studies were included in this review. Case reports, case series, case controls, cohort studies, secondary data analyses and a service delivery improvement project conducted in 26 countries made up the totality of the evidence. Most studies reported pregnancy complications for mothers (anaemia, postpartum haemorrhage, deaths) and fetuses or newborns (low birth weight, premature birth, and spontaneous or induced abortions). Few studies discussed the value of offering family planning to prevent adverse pregnancy outcomes. One study examined the effect of a provider training on contraceptive use with reported increased contraceptive use.ConclusionsIntegrating family planning services within a TB treatment programme is essential to reduce adverse TB-associated maternal-child outcomes. Despite well-established adverse pregnancy outcomes, little attention has been paid to family planning to prevent poor pregnancy outcomes for women with TB/DR-TB. Recommendations for clinicians, TB programmes and researchers are provided and reflect evidence presented in this review.

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Section: Discussionmentioning

confidence: 99%

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

et al. 2022

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“…Pulmonary tuberculosis can have diverse Ca s e R epo rt presentations ranging from cavitation, consolidation, tumorous lesions, lower lung filed tuberculosis and endobronchial and miliary nodules [2][3][4][5][6][7][8][9][10][11][12]. Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14]. Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14]. Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14]. High risk factors for tuberculosis would be advanced age, malnutrition, pregnancy, steroids exposure, diabetes mellitus and immunosuppression [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14]. High risk factors for tuberculosis would be advanced age, malnutrition, pregnancy, steroids exposure, diabetes mellitus and immunosuppression [9][10][11][12][13][14]. Tuberculosis in advanced stage may cause cardiac dysfunction and systemic effects which will have poor outcome if timely treatment not received [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Patil¹,

Gondhali²,

Choudhari³

et al. 2023

SAR J Med

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Tuberculosis is a more prevalent disease and the leading cause of death from an infectious agent in India. Tuberculosis in India accounts for the highest number of cases and deaths annually in the world. In spite of an efficient National tuberculosis control program for five decades, Tuberculosis is still the number one cause of death due to infectious agents in India and one third of total global deaths occurs in India due to this disease. Burden of drug sensitive and drug resistant cases is highest in the south east Asian region with maximum cases in India and China. India has launched a National strategic plan to end TB in 2017 with a target to eliminate TB by 2025. Main theme of the national strategic plan is ‘TB Free India’ with the vision of zero TB disease, zero deaths due to TB and decreasing poverty due to TB. Tuberculosis is an ancient disease and history traced before the evolution of mankind on this planet. Tuberculosis primarily affects the lung and is classified pathologically as primary, post-primary and progressive primary tuberculosis. In this case report, a 62-year male, presented with constitutional symptoms for six-month duration with partial response to medical treatment. He was having low grade fever, cough, shortness of breath, weight loss and anorexia for 6 months. His symptoms were progressive and empirically treated as enteric or typhoid fever for four to five occasions with oral and intravenous antibiotics with steroids with general physicians and family physicians. Additionally, he received empirical treatment as jaundice, viral fever, bronchitis, asthma, and generalised debilitating disease. Relatives brought to our center worsened general health with increased shortness of breath. Clinically he was having bilateral crepitations with decreased breath sounds right lower axillary and infrascapular area. Chest x-ray showed right pleural effusion with miliary opacities bilateral lung field. HRCT thorax showed typical miliary opacities with conglomerated pattern and pleural effusion on the right side of thorax. Pleural fluid analysis revealed exudative effusion with raised ADA level. He was unable to produce sputum, we have done bronchoscopy and BAL evaluation confirmed pulmonary tuberculosis and sensitivity pattern. BAL cytology documented acid-fast bacilli in smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. More awareness is required regarding symptoms, diagnosis and treatment of tuberculosis to family physicians and general practitioners as the majority of the rural population receives treatment from these health professionals.

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“…Tuberculosis in advanced stage may cause cardiac dysfunction and systemic effects which will have poor outcome if timely treatment not received [15][16][17]. Final outcome in delayed treatment initiation may lead to destroyed lung as post tuberculosis sequel and proportionate number of cases may have lung function abnormalities irrespective of radiological outcome [18][19][20][21][22][23][24]. Tuberculosis may be misdiagnosed due to confusing or overlapping clinical and radiological features in high burden setting like India [25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

Patil,

Patil

2023

SAR J Med

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Pleural effusion secondary to tuberculosis is second most common manifestation of extrapulmonary tuberculosis. Tuberculous pleural effusion is more frequently documented in India due to high TB burden setting and usually cured with universally available ATT as per NTEP program. Very few cases showed inadequate treatment response and these cases require addition of steroids to relive symptoms. Addition of steroids in management of TB pleural effusion is not routinely indicated and not recommended by NTEP as well. Clinical deterioration during antituberculosis therapy in patients whose cases have initially improved is known as a “paradoxical reaction.” In this case report, a 54-year teacher male presented with constitutional symptoms with right upper lobe nodular opacity with infiltrates treated empirically for community acquired pneumonia and progressed to left massive pleural effusion with respiratory distress diagnosed as case of Tuberculous pleural effusion by reporting raised ADA level and CBNAAT test results with MTB genome and negative Rifampicin (rpo-b) mutation. He is treated according to NTEP guided ATT schedule as per weight band in line with drug sensitive tuberculosis. He has shown good clinical and radiological response in first six weeks to ATT and later showed clinical and radiological worsening. We further reassessed and confirmed drug sensitive tuberculosis and continued same regimen. We have further evaluated for possibility of immune dysregulation in present case by doing TH1 and TH2 markers and observed TH1-TH2 dysregulation and also significantly raised IgE level. We have started oral steroids which were contoured till six weeks in tapering order along with ATT and documented significant improvement in clinical and radiological response. We have observed near complete resolution of pleural effusion after seven months and documented clinical and radiological cure after eight months of ATT. Paradoxical reaction is not uncommon, but needs prompt workup to rule out underlying drug resistant tuberculosis. Short course of steroids will give symptomatic relief in drug sensitive tuberculosis along with ATT. We recommend to rule out immune dysregulation in cases with drug sensitive recurrent pleural effusion in spite of acceptable adherence with good quality drugs for adequate duration which have showed excellent initial response to ATT.

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Laryngeal & Lower lung field tuberculosis in pregnancy: A case report

Cited by 4 publications

References 1 publication

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

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