Tuberculosis and viral hepatitis in pregnancy by srajan jaiswal 510.pptx

Tuberculosis and viral hepatitis in pregnancy by srajan jaiswal

1. Presented by srajan jaiswal Tuberculosis and viral hepatitis in pregnancy

2. overview Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis, which can affect any part of the body. Pregnant women are at increased risk of developing TB due to various factors, including: Immune suppression: Pregnancy can weaken the immune system, making it easier for the bacteria to infect the body. Malnutrition: Poor nutrition during pregnancy can increase the risk of developing TB. Crowded living conditions: Living in crowded areas with poor ventilation can increase the risk of exposure to TB. TB in pregnancy can have serious consequences for both the mother and the fetus. If left untreated, TB can lead to: Maternal mortality: Untreated TB can lead to severe respiratory complications, such as pneumothorax or respiratory failure, which can be life-threatening. Fetal mortality: Untreated TB during pregnancy can increase the risk of fetal death, preterm labor, and low birth weight. Vertical transmission: There is a risk of transmitting TB to the baby during pregnancy, childbirth, or breastfeeding.

3. Symptoms of Tuberculosis in Pregnancy The symptoms of TB in pregnancy are similar to those in non-pregnant individuals, including: Coughing for more than 3 weeks Chest pain Fatigue Weight loss Fever Night sweats Coughing up blood In pregnant women, TB may also present with symptoms specific to pregnancy, such as: Preterm labor Prolonged labor Fetal distress

4. Types of TB in Pregnancy Pulmonary TB: most common form of TB in pregnancy, affects the lungs Extrapulmonary TB: affects organs outside the lungs, including lymph nodes, meninges, gastrointestinal system, and genitourinary system Miliary TB: affects multiple organs simultaneously, causing small nodules or lesions Congenital TB: rare and often fatal, occurs when a fetus is infected with TB during pregnancy Neonatal TB: occurs in newborns who are infected with TB during birth or shortly after birth

5. Types of Latent Tuberculosis Infection (LTBI) in Pregnancy Primary LTBI: initial infection with M. tuberculosis, often asymptomatic Reactivation LTBI: reactivation of a previously dormant infection, often due to immunosuppression or other factors Post-primary LTBI: infection with M. tuberculosis after initial infection has resolved, often due to re-exposure to infected individuals

6. Screening The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for TB using a Mantoux tuberculin skin test (TST) or an interferon-gamma release assay (IGRA). The TST is a simple test that involves injecting a small amount of tuberculin into the skin and measuring the induration (thickness) after 48-72 hours.

7. treatment Antitubercular Therapy (ATT) Regimens The following ATT regimens are recommended for pregnant women with active TB: Rifampicin-based regimen Rifampicin (RIF): 600-800 mg daily, taken with food Isoniazid (INH): 300-600 mg daily, taken with food Pyrazinamide (PZA): 2-3 grams daily, taken with food Ethambutol (EMB): 15-20 mg/kg daily, taken with food Duration: 6 months Rifampicin-free regimen Isoniazid (INH): 300-600 mg daily, taken with food Pyrazinamide (PZA): 2-3 grams daily, taken with food Ethambutol (EMB): 15-20 mg/kg daily, taken with food Streptomycin (SM): 1-2 grams daily, intramuscularly Duration: 9 months

8. Additional Medications In addition to the ATT regimens, the following medications may be prescribed to pregnant women with TB: Antiretroviral therapy (ART) : For pregnant women with HIV who are co-infected with TB. Zidovudine (AZT) + Lamivudine (3TC) + Lopinavir /Ritonavir ( Kaletra ): AZT: 300 mg, orally, twice daily 3TC: 150 mg, orally, twice daily Kaletra : 400/100 mg, orally, twice daily Fluoroquinolones : For pregnant women who are unable to tolerate the standard ATT regimens . Levofloxacin ( Levaquin ): 500-750 mg, orally, once daily Moxifloxacin ( Avelox ): 400-800 mg, orally, once daily Thioacetazone : For pregnant women who are allergic to rifampicin or sulfonamides . 50-100 mg, orally, once daily

9. Dose Adjustments Dose adjustments may be necessary for pregnant women who have a low body mass index (BMI), are taking other medications that interact with ATT drugs, or have kidney or liver dysfunction. Monitoring and Follow-up Close monitoring and follow-up are essential for pregnant women with TB. The following tests should be performed regularly: TB cultures : To monitor the effectiveness of treatment and detect any drug resistance. Complete blood count (CBC) : To monitor for anemia and other hematological abnormalities. Liver function tests (LFTs) : To monitor for liver dysfunction. Renal function tests (RFTs) : To monitor for kidney dysfunction. Breastfeeding and ATT Breastfeeding is not recommended during treatment with rifampicin due to its potential to reduce milk production. However, breastfeeding is not contraindicated during treatment with other ATT drugs. Pregnancy and Breastfeeding Considerations Pregnant women with TB should be advised to avoid close contact with others until they are no longer contagious. Breastfeeding is not recommended during treatment with rifampicin, but it is not contraindicated during treatment with other ATT drugs.

10. First-line treatment The first-line treatment for TB in pregnancy includes isoniazid, rifampin, ethambutol , and pyrazinamide. These medications are considered safe for use in pregnancy. However, it's important to note that rifampin may interact with low-dose oral contraceptives, making them less effective, and may also decrease maternal and infant vitamin K levels. Therefore, supplementation is recommended. Streptomycin Streptomycin is not recommended for use in pregnancy due to its risk of auditory and vestibular damage. Second-line treatment Second-line treatment has been used less extensively in pregnant patients. The risks of treatment-related complications are less commonly reported than TB-associated complications. Additional considerations For patients with HIV co-infection or multidrug-resistant strains, treatment is more complicated and may have increased frequency of treatment-related side-effects. In these cases, the direction of care should be referred to clinicians with expertise in the field. Initiation of treatment It's essential to initiate treatment for active TB as soon as possible. If pregnancy occurs during treatment, it should not be suspended. There is no basis for recommending therapeutic abortion due to the overall safety of first-line TB medication. Pyridoxine supplementation Pyridoxine (vitamin B6) at 10-25 mg should be added to any isoniazid-containing regimen to prevent neurotoxicity.

11. Viral hepatitis Introduction Viral hepatitis is a significant public health concern worldwide, particularly in pregnancy. The World Health Organization (WHO) estimates that approximately 15 million women are infected with hepatitis viruses each year, with a significant proportion of these cases occurring during pregnancy. Viral hepatitis can have devastating consequences for both the mother and the fetus, highlighting the need for accurate diagnosis, effective treatment, and prevention strategies . Classification Viral hepatitis is classified into five types: A, B, C, D, and E. The most common types affecting pregnant women are hepatitis B (HBV) and hepatitis C (HCV).

12. Hepatitis B Virus (HBV) HBV is a DNA virus that can cause acute or chronic infection. Chronic HBV infection is associated with increased risk of liver disease, liver cancer, and maternal-fetal transmission. Mother-to-child transmission of HBV occurs during childbirth, particularly if the mother is not vaccinated or has not received antiviral treatment . Symptoms: Fatigue , loss of appetite, nausea and vomiting, abdominal pain, jaundice, itching, fever, swollen lymph nodes, and hepatosplenomegaly . Additional symptoms may include premature rupture of membranes, preeclampsia, fetal growth restriction, and neonatal complications. Some women with HBV may not exhibit symptoms during pregnancy, but can still transmit the virus to their newborns. Complications of HBV in pregnancy can include: Maternal mortality due to liver failure, sepsis, or bleeding complications Fetal mortality due to premature birth, growth restriction, or intrauterine infection Neonatal mortality due to complications related to HBV infection or prematurity Long-term sequelae such as chronic liver disease, liver cirrhosis, or liver cancer in the mother

13. Hepatitis C Virus (HCV) HCV is a flavivirus that can cause acute or chronic infection. Chronic HCV infection is associated with increased risk of liver disease and liver cancer. Mother-to-child transmission of HCV occurs during childbirth, but is less common than HBV transmission . the risk of transmission is relatively low, around 5-6%. Symptoms : The physical examination may reveal right hypochondrial tenderness, hepatomegaly, and splenomegaly . .  loss of appetite, abdominal pain, dark urine, and jaundice (yellowing of the skin and eyes ). Laboratory tests show elevated levels of transaminases (ALT and AST) and bilirubin, which can be used to diagnose the condition

14. symptoms Symptoms The symptoms of viral hepatitis in pregnancy can vary depending on the type of virus and the severity of the infection. Common symptoms include: Fatigue Loss of appetite Nausea and vomiting Abdominal pain Dark urine and pale stools Yellowing of the skin and eyes (jaundice)

15. Diagnosis The diagnosis of viral hepatitis in pregnancy is typically based on a combination of laboratory tests and clinical evaluation. The following tests are commonly used : Hepatitis serology: Testing for HBV surface antigen ( HBsAg ), anti- HBc antibody, and anti-HBs antibody . Liver function tests: Measuring alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin levels . Polymerase chain reaction (PCR): Testing for viral load and genotyping.

16. treatment Acute Viral Hepatitis (AVH) in Pregnancy Supportive care: Fluid replacement: IV fluids to prevent dehydration and electrolyte imbalance Nutrition: Encourage adequate caloric intake and consider enteral nutrition if necessary Antiemetics : Metoclopramide or ondansetron to manage nausea and vomiting Antiviral therapy is not recommended for AVH in pregnancy, as the benefits are limited and the risk of fetal harm is unknown. Chronic Hepatitis B (CHB) in Pregnancy Antiviral therapy: Lamivudine ( Epivir ): 100 mg/day, orally, from 24-28 weeks of gestation to delivery Telbivudine ( Tyzeka ): 600 mg/day, orally, from 24-28 weeks of gestation to delivery Tenofovir disoproxil fumarate ( Viread ): 300 mg/day, orally, from 24-28 weeks of gestation to delivery Hepatitis B immunoglobulin (HBIG) and HBV vaccination: Administer HBIG (10 mg/kg) within 12 hours of birth to reduce the risk of transmission Administer HBV vaccination (first dose at birth, followed by second dose at 1-2 months, and third dose at 6-18 months )

17. Thank you for your attention.