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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
TB is a bacterial infection due to Mycobacterium tuberculosis. The pathogenesis of tuberculosis infection and disease in pregnant women is similar to that in nonpregnant women. Infection is primarily pulmonary, though extrapulmonary spread is common. Spread (by airborne droplets) is facilitated by the ability of these small particles to remain airborne for hours after being emitted from an infected respiratory tract. Once inhaled, M. tuberculosis may (1) be cleared from the body, (2) produce an active infection, (3) produce an asymptomatic latent infection, or (4) reactivate into an active infection months to years later. When M. tuberculosis is taken up by alveolar macrophages, the infection may either be contained by granuloma formation or may progress to active disease [97]. Most patients develop cell-mediated immunity, which is demonstrated by conversion of the tuberculin skin test (TST), and which constitutes latent tuberculosis infection. In some patients, the replication of M. tuberculosis cannot be contained, and active disease occurs. Latent tuberculosis infection can spontaneously develop into active tuberculosis, especially in individuals with risk factors. Pulmonary disease is the most common but not the only form of active tuberculosis. Twenty percent of cases (extrapulmonary tuberculosis) can manifest as meningitis, osteitis, genitourinary involvement, or disseminated disease.
Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Over 11,000 active cases of tuberculosis were reported in the United States in 2009 (74). Pregnancy does not appear to change the pathogenesis or disease progression of tuberculosis (75). Skin testing is safe and the results are not altered by pregnancy. However, routine testing for latent tuberculosis is not recommended unless the woman has a specific risk of quick progression from latent to active disease such as HIV infection or a recent significant exposure. Skin testing during pregnancy indicates that the practitioner has an intention to treat during pregnancy. In that setting, a positive skin test warrants a chest X-ray and evaluation to rule out active disease and then prophylactic therapy with isoniazid. In everyone other than those with immunosuppression or a recent exposure, testing and/or latent tuberculosis therapy should be deferred until at least the third month postpartum, since the risk of isoniazid hepatotoxicity is increased during pregnancy and the early postpartum period (76–78).
Infectious Diseases
Published in Lyle D. Broemeling, Bayesian Analysis of Infectious Diseases, 2021
Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis.
Risankizumab in psoriasis: prior biologics failure does not impact on short-term effectiveness
Published in Expert Opinion on Biological Therapy, 2022
Raquel Rivera-Díaz, Mar LLamas-Velasco, Mercedes Hospital, Isabel Martín, Ofelia Baniandrés, Diana Ruíz-Genao, Pablo de la Cueva, Carmen García-Donoso
Data from 44 patients with moderate-to-severe plaque psoriasis were available, with a mean (SD) age of 52.8 (15.5) years, and mostly male (n/N = 29/44, 65.9%). At baseline, the mean BMI of the patients was 30.2 (6.1) kg/m2. Mean duration of psoriasis since the first diagnosis was 22.5 (13.5) years, and mean baseline PASI scores were 12.3 (6.7). Our cohort of patients used on average 2.7 (1.9) conventional systemic agents, and 84% had been treated in the past with at least one biologic agent with a mean of 1.9 (1.4), such as an anti-tumor necrosis factor (TNF) agent (n/N = 24/44, 64.8%), ustekinumab (n/N = 19/44, 51.3%), anti-IL-17 (n/N = 12/44, 32.4%) or guselkumab (n/N = 1/44, 2.2%). Among our patients, most of the patients (81.8%) had at least one comorbidity, with hepatic steatosis (n/N = 18/44, 40.9%), dyslipidemia (n/N = 18/44, 40.9%) and hypertension (n/N = 17/44, 38.6%) being the most prevalent. Eight patients (18.8%) had psoriatic arthritis, and two (4.5%) had previous malignancy. Latent tuberculosis was diagnosed in 14 patients (31.8%), and one patient had active tuberculosis in the past, which was treated appropriately. Other reported infections in our cohort were human immunodeficiency virus (HIV) (n/N = 2/44, 4.5%), hepatitis B (n/N = 5/44, 11.3%) and hepatitis C (n/N = 2/44, 4.5%). Seven patients (16%) did not receive an induction dose.
The risk factors and incidence of major infectious diseases in patients with ankylosing spondylitis receiving tumor necrosis factor inhibitors
Published in Modern Rheumatology, 2021
Bon San Koo, Yu-Cheol Lim, Min-Young Lee, Ja-Young Jeon, Hyun-Jeong Yoo, In-Sun Oh, Ju-Young Shin, Tae-Hwan Kim
The incidence rate of tuberculosis is an important issue in patients using TNFis. South Korea remains one of the countries with an intermediate tuberculosis burden, and the incidence rate was reported at 70 per 100,000 person-years by the World Health Organization in 2017. Moreover, the incidence of tuberculosis is high in patients treated with biologics despite aggressive treatment for latent tuberculosis infection [23,24]. In our study, the incidence rate of tuberculosis was 4.90 per 1000 person-years, which appeared to be lower than that of patients with AS in a previous study (715 per 100,000 person-years) that queried the HIRA database from 2005 to 2009 [23]. Although screening and treatment for latent tuberculosis infection have been emphasized, it seems that tuberculosis still develops frequently in patients treated with TNFi. More aggressive prevention is needed to treat latent tuberculosis and to prevent its transmission in patients treated with TNFis. Interestingly, in our study, risk factors such as age, comorbidity, and steroids usage observed in other infections were not related to the increased risk of tuberculosis. Therefore, studies from various perspectives are needed to determine the categories of patients that are susceptible to tuberculosis.
Old biomarkers in tuberculosis management: are they still useful? a systematic review
Published in Expert Review of Anti-infective Therapy, 2021
Lara Fusani, Chiara Tersigni, Elena Chiappini, Elisabetta Venturini, Luisa Galli
All the included studies described in their methods section the TB case definition, according to international TB reference standard, even if a proper reference was not always indicated for each article. Active TB was defined when microbiologically confirmed on sputum smear samples. However, especially in children, due to the difficulties reported in isolating M. tuberculosis and in collecting adequate samples, the microbiological diagnosis was integrated with an algorithm which included a) contact with a source TB case b) symptoms and signs of active TB c) signs of active TB in chest radiograph. Extra-pulmonary TB (EPTB) was described according to symptoms, clinical signs, imaging results, biopsies and histological features of other organs involved [13]. Latent tuberculosis infection (LTBI) was diagnosed in patients with a positive Mantoux and/or IGRAs, no symptoms of TB, and no findings in chest X-ray of active TB [4].