A Review on Placental Tuberculosis

Abstract

Tuberculosis has re-emerged as a serious health concern as a result of AIDS epidemic, immigration from areas where the disease is endemic and multi drug resistance, with 8.8 million patients affected worldwide in 2010. Infections with mycobacterium tuberculosis (MTb) are globally prevalent in many countries, yet descriptions of placental pathology in tuberculous patients are few. Moreover, the diagnosis of tuberculosis in pregnant patients can be missed or delayed owing to the insidious onset and variability of clinical presentation, often overlapping with non-specific symptoms common in pregnancy such as loss of appetite, malaise and lethargy. The exact incidence of tuberculosis in pregnancy is not readily available in many countries due to confounding factors. However, it is expected that the incidence of tuberculosis in pregnant women is high as in general population, with higher incidence in developing countries. Placental tuberculosis shows predominantly neutrophilic and histiocytic response in the form of villitis and intervillitis which is due to the innate immune response. This innate response contributes more to tissue injury than protection as proved in our case, where it led to intrauterine death of the fetus. We, hereby report a case of placental tuberculosis, diagnosed on histopathological examination of placenta showing caseating epithelioid cell granulomas with langhan’s giant cells and Acid Fast Bacilli on Zeihl Neilson stain.

Tuberculosis in pregnancy

“…Alternatively, ruptured infective foci in the placenta contaminates amniotic fluid, which upon fetal aspiration or ingestion leads to a primary focus in the lungs or gastrointestinal tract. Placental TB infection per se leads to neutrophilic and histiocytic responses causing villitis and intervillitis, tissue injury, and even intrauterine fetal death [ 94 ]. After birth, neonatal exposure to an open infectious sputum-positive case leads to postnatal infection.…”