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Untitled Prezi

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by

Dr.Ahmed Sameh

on 20 September 2013

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Transcript of Untitled Prezi

Fetal Infection
Tuberculosis
TB infection
Latent TB (LTB)
Active TB (ATB)
37 years old indian female patient came to your office worried about her 16 weeks pregnancy as her husband developed open active TB. Recently she complained from night fever and morning wet cough Her Mantoux test was positive for TB and she was negative for HIV infection. What is the best next step in management?
Positive
Negative
Mantoux
How is POSITIVE?
More than 15 mm
in low risk pop
General population with regular BCG vaccination
More than 10 mm
in high risk pop
HIV -ve drug abusers
Residents of long term care facilities ( mental institutions, prisons)
chronic deblitating illness
Endemic areas
Healthcare workers
More than 5 mm
in highest risk pop
HIV +ve drug abusers
Contact with open active TB
Old healed TB on chest xRay
THE LUCKY

WE WILL DO NOTHING
is it Active or Latent?
= we have a case of TB with pregnancy ... ok what's next?
= Prophylaxis
= Treatment
Active=treatment
Latent=prophylaxis
it may reveal open active TB, old healed Tb or otherwise normal figure
Chest XRay
for acid fast bacilli
Sputum Examination
Night sweats
Anorexia
Fatigue
Weight loss
Hemoptysis
Signs and symptoms
HIV positive or negative?
HIV serology
Management plan
Chest XRay
Normal
Old healed TB
Open TB
Active TB
Antenatal treatment

Send for culture and sensitivity first

Sputum
examination
Negative
Positive
Negative
Positive
HIV serology
No
Risk Group
Yes
Antenatal Prophylaxis
starting from the second trimester
More than 35 years
Less than 35 years
Postpartum prophylaxis
No Treatment
Medication options
Treatment
Isoniazide plus vitamin B6
Ethambutol
Rifampicin
Pyrazinamide
Anteatal prophylaxis
Isoniazide + vitamine B6 for 6 months from the second trimester
Postpartum prophylaxis
INH + vitamin B6 for 6 months postpartum
Breastfeeding
Is allowed
Neonate of INH taking mother should receive a course of vitamin B6
Neonate should be applied for full TB screening and assessment

Neonatal TB
Congenital infection
: very rare ( part of miliary TB)
Neonatal infection
: Contact with mother
Contraindications
Strptomycin
: cranial nerve 8 damage, group D

all other medications: between B and C group, posses some hazards

BUT UNTREATED TB IS MUCH MORE HAZARDOUS
Risk group?
Normal, high
or highest?
3 Qs.
Effect of TB on pregnancy:
PTL
IUGR
SAB
RPL

Effect of pregnancy on TB:
Nothing
Full transcript