Pillay T, Sturm A W, Khan M, Adhikari M, Moodley J, Connolly C, Moodley D, Padayatchi N, Ramjee A, Coovadia H M, Sullivan J L
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
Int J Tuberc Lung Dis. 2004 Jan;8(1):59-69.
Increases in perinatal TB have paralleled the exacerbation of the TB epidemic in KwaZulu Natal. The exact risks for vertical transfer of Mycobacterium tuberculosis (VTRTB) to the baby are unknown, as is the impact of HIV-1 co-infection, which frequently accompanies maternal TB disease in the region.
Prospective case series study of 82 HIV-1-infected and 25 non-infected pregnant mothers, King Edward VIII Hospital, KwaZulu Natal, South Africa.
Perinatal mortality in HIV-1/TB diseased mothers was 85/1000 and associated with maternal anaemia (P = 0.02); 46% of newborns were premature, 66% low birth weight and 49% intrauterine growth restricted. These were significantly higher than overall hospital rates (P < 0.01, OR 4.8, 95%CI 3.2-7.0). Sites of detection of maternal TB, distribution of bacteriologically-proven TB, obstetric comorbidity and perinatal morbidity were similar in HIV-1-infected and non-infected mothers. VTRTB was detected in 16 newborns (16%), occurring similarly in bacteriologically-proven and suspected maternal TB disease, with no difference between HIV-1-infected and non-infected mothers. Eleven newborns with VTRTB were HIV-1 exposed; 64% acquired HIV-1 and died from rapidly progressive disease by 10 months of age. HIV-1-infected mothers and their exposed newborns had significantly lower CD4 counts. No association between perinatal maternal viral load, CD4 count or VTRTB was detected.
Mothers with TB disease in pregnancy are at risk for significant perinatal morbidity, mortality and VTRTB.
夸祖鲁-纳塔尔省围产期结核病的增加与结核病疫情的加剧同步。结核分枝杆菌垂直传播（VTRTB）给婴儿的确切风险尚不清楚，该地区孕产妇结核病常伴随的HIV-1合并感染的影响也不清楚。
对南非夸祖鲁-纳塔尔省爱德华八世国王医院的82名感染HIV-1的孕妇和25名未感染的孕妇进行前瞻性病例系列研究。
感染HIV-1/结核病的母亲围产期死亡率为85/1000，与母亲贫血有关（P = 0.02）；46%的新生儿早产，66%出生体重低，49%宫内生长受限。这些比例显著高于医院总体水平（P < 0.01，OR 4.8，95%CI 3.2 - 7.0）。感染HIV-1的母亲和未感染的母亲在孕产妇结核病检测部位、细菌学确诊结核病的分布、产科合并症和围产期发病率方面相似。在16名新生儿（16%）中检测到VTRTB，在细菌学确诊和疑似孕产妇结核病中发生率相似，感染HIV-1的母亲和未感染的母亲之间无差异。11名感染VTRTB的新生儿暴露于HIV-1；64%感染了HIV-1，并在10个月大时死于快速进展性疾病。感染HIV-1的母亲及其暴露的新生儿CD4细胞计数显著较低。未检测到围产期母亲病毒载量、CD4细胞计数或VTRTB之间的关联。
孕期患结核病的母亲有发生严重围产期发病、死亡和VTRTB的风险。
