title: Tuberculosis during Pregnancy in Northern Israel, 2002-2012: Epidemiology and Clinical Practices.
abstract: BACKGROUND
  Atypical presentation of tuberculosis (TB) during pregnancy may cause diagnostic delay and adversely influence pregnancy outcome.
  
  
  OBJECTIVE
  To examine the incidence and clinical and epidemiological features of TB during pregnancy and investigate infection control measures at delivery and during the postpartum period.
  
  
  METHODS
  We retrospectively evaluated all reported cases of TB diagnosed during pregnancy to 6 months postpartum in Israel's Northern Health District (2002-2012).
  
  
  RESULTS
  Active TB was detected in six patients; all were negative for human immunodeficiency virus (HIV). Two patients were diagnosed in the postpartum period, and four had pulmonary involvement. The average incidence during this period (3.9 per 100,000 pregnancies) was similar to that in the general population. Five patients were at high risk of contracting TB due to either recent immigration from a high-burden country or being in contact with another individual with active TB. Patients with pleuropulmonary involvement had prolonged cough and abnormal chest X-rays, without fever. Diagnosis was delayed for 3 to 7 months from symptom onset. Investigation of the newborn to rule out intrauterine infection was conducted in only one of four relevant cases. All patients were infected with organisms susceptible to all first-line drugs, and all were cured with standard therapy.
  
  
  CONCLUSIONS
  There was a considerable delay in the diagnosis of TB among pregnant women, and investigation of the newborn upon delivery to rule out TB infection was routinely omitted. Effective management of TB during pregnancy and the postpartum period requires a multidisciplinary approach including an obstetrician, pediatrician, TB specialist, and public health physician.
authors.forename: Hashem
authors.initials: H
authors.lastname: Bishara
authors.forename: Noam
authors.initials: N
authors.lastname: Goldstein
authors.forename: Marwan
authors.initials: M
authors.lastname: Hakim
authors.forename: Olga
authors.initials: O
authors.lastname: Vinitsky
authors.forename: Danit
authors.initials: D
authors.lastname: Shechter-Amram
authors.forename: Daniel
authors.initials: D
authors.lastname: Weiler-Ravell
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data; D007557:Israel / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents