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Tuberculosis: Infertility and Pregnancy

Dr. Nasir

Tuberculosis:  Infertility and Pregnancy.

Background: According to WHO, Tuberculosis (TB) is one of the top 10 causes of death worldwide. In 2015, 10.4 million people fell ill with TB and 1.8 million died from the disease (including 0.4 million among people with HIV). Over 95% of TB deaths occur in low- and middle-income countries. World TB Day celebrated on 24 March each year, is an opportunity to raise awareness about the burden of tuberculosis (TB) worldwide and the status of TB prevention and care efforts.

Tuberculosis (TB) is a highly infectious disease, caused by a bacterium called Mycobacterium tuberculosis. Impact of Tuberculosis on human life was continued to be so devastating that in 1993 the World Health Organization (WHO) declared that TB as a global emergency; the first time that a disease had been labelled as such. TB affects all age groups and all parts of the world. However, the disease mostly affects young adults, and people living in developing countries. This disease is an important cause of infertility, menstrual irregularity, pregnancy loss, and in association with pregnancy, morbidity to both the mother and child increases. The exact incidence of tuberculosis in pregnancy is not readily available in many countries due to a lot of confounding factors. It is, however, expected that the incidence of tuberculosis among pregnant women would be as high as in the general population, with possibly higher incidence in developing countries.

Tuberculosis (TB) is a top infectious disease killer worldwide. According to WHO in 2014 about 9.6 million people fell ill with TB and 1.5 million died from the disease. Tuberculosis is an airborne disease meaning that bacteria cause this disease spreads through air. When an infected person coughs, sneezes, speaks, laughs etc, bacteria spread in air and the people nearby may breathe in theses bacteria and become infected. TB is spread most easily in closed spaces over a long period of time.

People with latent infection will not impose threat to other people.  But when latent infection converted to active TB because of impaired immune system can spread disease to others.  The TB bacteria usually attack the lungs, but can also infect any part of the body such as kidney, spine,brain and endometrium.

There are two main types of TB: a) Latent TB and b) active TB. In latent TB, the TB bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active. In active TB, the bacteria do cause symptoms and can be transmitted to others. As active TB poses grave maternal and perinatal risks, early, appropriate and adequate anti-TB treatment is a mainstay for successful pregnancy outcome.

Multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB)

About 3.7% of new tuberculosis cases have MDR-TB. It is defined as TB that is resistant to at least 2 most powerful first-line treatment anti-TB drugs (isoniazid and rifampicin).  Drug resistance occurs primarily because of improper treatment of standard TB, but resistant strains are also being spread from person-to-person. According to WHO 480000 people developed multi drug resistant tuberculosis (MDR-TB) in the world in 2014.  Cases of tuberculosis that are resistant to virtually all drugs currently available (XDR-TB) are increasing at an alarming rate around the world. These cases are particularly difficult and expensive to both diagnose and treat, factors that lead to a major treatment access gap.

Symptoms:

A person with TB infection will have no symptoms. A person with active TB disease may have any or all of the following symptoms: A persistent cough last longer than three weeks, chest pain, weight loss, loss of appetite, fever, coughing up blood, night sweats.

Diagnosis:

Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present. FDA approved Xpert® MTB/RIF – Two-hour detection of MTB and rifampin resistance mutations. Molecular assays based on nucleic acid amplification techniques such as polymerase chain reaction (PCR) have been developed for rapid TB diagnosis and are being implemented in developing countries.

A commercial molecular assay Loopamp MTBC Detection Kit based on loop-mediated isothermal amplification for the detection of Mycobacterium tuberculosis complex (TB-LAMP). TB-LAMP is a manual assay that requires less than one hour to perform and can be read with the naked eye under ultraviolet light. WHO recommends that TB-LAMP can be used as a replacement for microscopy for the diagnosis of pulmonary TB in adults with signs and symptoms of TB.

Treatment:

TB is a treatable and curable disease; with proper treatment TB is completely curable. But still we see high mortality rate due to TB. The major problem associated with treatment of TB is prolonged treatment, high pill burden which leads to low or non-compliance of patients to current therapy.  low compliance of patients are the main contributory factor in the reemergence of the disease and the development of multi-drug resistant (MDR) Tuberculosis and more severe form called as extensive drug-resistant (XDR) tuberculosis. Moreover, the prevalence of multidrug resistance tuberculosis (MDR-TB and XDR-TB) is increasing in developing countries. That causes a challenge to the medical sciences and became matter of great concern. Unfortunately we don’t have effective treatment against MDR and XDR.

The aims of TB treatment are: To cure the patient of TB and restore their quality of life and productivity; to prevent relapse of TB; to reduce the transmission of TB to others; to prevent the development and transmission of drug resistant TB.

Prevention:

To prevent spreading TB, it is important to get treatment quickly and to complete the treatment course. This can stop transmission of the bacteria and the appearance of antibiotic-resistant strains. According to WHO 43 million lives were saved through effective diagnosis and treatment between 2000 and 2014.

If a positive skin test is detected and other tests have confirmed that active TB is not present, your doctor may choose to prescribe a medication that prevents a TB infection from progressing to the active disease. The antibiotic most commonly used is isoniazid, which is usually taken daily for 9 months. Other medications that may be used include rifampin or a combination of isoniazid and rifampin.

It is important to take your medications for as long as your doctor recommends. If you stop taking your medications before your doctor suggests, the TB infection can recur, you could get active TB, or the TB bacteria may become resistant to the medications you are taking.

If you have become infected with TB, but do not have active TB disease, you may get preventive therapy. This treatment kills germs that are not doing any damage right now, but could so do in the future. The most common preventive therapy is a daily dose of the medicine isoniazid (INH) for 6 to 9 months. If you take your medicine as instructed by your healthcare provider, it can keep you from developing active TB disease.

There is a vaccine against TB called BCG, which is unfortunately less effective against the adult pulmonary TB but effective at reducing the incidence of TB in children. The prevention, however, goes beyond this as it is essentially a disease of poverty. Improved living condition is, therefore, encouraged with good ventilation, while overcrowding should be avoided. Improvement in nutritional status is another important aspect of the prevention.

Follow the link for review on  Nanotechnology-Based Approach in Tuberculosis Treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292193/

Dr. Nasiruddin, Ph.D ( Molecular Infectious), National Institute of Nutrition, Hyderabad, India.

August 18, 2016

 

 

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