Detecting tuberculosis in pregnant and postpartum women in Eswatini

Abstract

Background Tuberculosis diagnosis in pregnancy is complex because tuberculosis symptoms are often masked by physiological symptoms of pregnancy. Untreated tuberculosis in pregnant and postpartum women may lead to maternal morbidity and low birth weight. Tuberculosis in HIV-positive pregnant women increases the risk of maternal and infant mortality. Objective This study aimed to determine tuberculosis prevalence stratified by HIV status and identify screening algorithms that maximise detection of active tuberculosis among pregnant and postpartum women in Eswatini. Methods Women were enrolled at antenatal and postnatal clinics in Eswatini for tuberculosis screening and diagnostic investigations from 01 April to 30 November 2015 in a cross-sectional study. Sputum samples were collected from all participants for tuberculosis diagnostic tests (smear microscopy, GeneXpert, MGIT culture). Blood and urine samples were collected from HIV-positive women for cluster-of-differentiation-4 cell count, interferon gamma release assay and tuberculosis lateral flow urine lipoarabinomannan tests. Results We enrolled 990 women; 52% were pregnant and 47% were HIV-positive. The prevalence of tuberculosis among HIV-positive pregnant women was 5% (95% confidence interval [CI]: 2–7) and among postpartum women it was 1% (95%CI: -1–3). Tuberculosis prevalence was 2% (95%CI: 0–3) in HIV-negative pregnant women and 1% (95%CI: -1–2) in HIV-negative postpartum women. The national tuberculosis symptom screening tool failed to identify women who tested tuberculosis-culture positive. Conclusion Routine tuberculosis symptom screening alone is insufficient to rule out tuberculosis in pregnant and postpartum women. Only sputum culture maximised the detection of tuberculosis, indicating a need to balance access and cost in developing countries.

Prevalence, acceptability, and cost of routine screening for pulmonary tuberculosis among pregnant women in Cotonou, Benin

“…The city of Cotonou, with a population of approximately 685,000, was where the study was implemented. HIV prevalence in the city of Cotonou is higher than other cities at 1.9% [ 11 ] and approximately the same among pregnant women with known HIV status (1.6%) [ 11 ]. The study included eight health centers—three public, three religious, and two private facilities—collaborating with the national tuberculosis programme and conducting antenatal care (ANC) activities.…”

“…In Pakistan, though 2.6% of pregnant women had symptoms consistent with TB, only 0.025% were diagnosed with TB [ 10 ]. Comparatively, in eSwatini, TB prevalence was 2% among HIV-negative pregnant women [ 11 ], while in South Africa, among pregnant women living with HIV, 16% had TB symptoms, and 2.5% had TB [ 12 ].…”

Lipoarabinomannan as a Point-of-Care Assay for Diagnosis of Tuberculosis: How Far Are We to Use It?

“…Reports indicate that LAM can be found in urine, serum, and lung from TB patients (Broger et al, 2019b;Brock et al, 2020;De et al, 2020). Recent clinical studies indicate that maternal milk could be an additional source of LAM in pregnant women (García et al, 2019;Pasipamire et al, 2020). Moreover, it is possible to observe variations in the profile of circulatory cell subpopulations, cell surface markers, and circulating soluble proteins in patients with latent ( L TB), subclinical, or active ( A TB) TB.…”

African laboratory medicine in the time of COVID-19

“…Volume 9, Issue 1 of AJLM goes beyond chronicling a broad range of infectious disease catastrophes to outlining lessons learned that will strengthen health systems. 3 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 While most pandemic activity has focused on reverse transcription polymerase chain reaction and other forms of testing to support the identification of cases and transmission chains, 10 other domains of laboratory medicine have made important contributions that shed more light on the pathogenesis of the disease, and therefore how best to improve treatment. 19 , 20 …”

“…Volume 9, Issue 1 of AJLM goes beyond chronicling a broad range of infectious disease catastrophes to outlining lessons learned that will strengthen health systems. 3,9,10,11,12,13,14,15,16,17,18 While most pandemic activity has focused on reverse transcription polymerase chain reaction and other forms of testing to support the identification of cases and transmission chains, 10 other…”