Abstract:

The clinical data of 15 pregnant women with tuberculosis who admitted to the tuberculosis Department of Chongqing Public Health Medical Treatment Center from January 1, 2017 to September 30, 2019 were collected. The clinical manifestations, treatment delays, imaging manifestations, immune response status, therapeutic effect and fetal outcome of pregnant women with tuberculosis were summarized. The main clinical manifestations of pregnant women with tuberculosis were fever, fatigue and cough, and the main clinical manifestations of tuberculous meningitis were headache. For treatment delays, 12 pregnant women had different degrees of delayed treatment with the shortest delayed days of 20 days, the longest of 252 days, and the median delayed days of 78 days. Chest CT scan showed 4 patients with multi-lobal patchy of both lungs with exudative shadows or cavities, 12 patients with diffuse miliary nodules in the lungs, and 10 patients with unilateral or bilateral pleural effusions or pleura thickening. Eleven patients with tuberculous meningitis underwent head MRI, which showed 9 cases of cerebral parenchymal nodules and patchy lesions, 8 cases of thickened meninges, 2 cases of cerebral edema, and 1 case of thickened spinal membrane.. Immune response results showed that the values of CD4 ⁺T cells decreased in 10 pregnant women, CD8 ⁺T cells decreased in 9 pregnant women, and CD4 ⁺ T/CD8 ⁺ T ratio decreased in 11 pregnant women. After treatment, 14 patients improved after treatment with anti-tuberculosis drugs, and 1 patient was hospitalized for severe tuberculous meningitis. In terms of fetal outcome, there were 10 naturally conceived fetuses, 1 abortion, 1 stillbirth, and 8 deliveries (including 2 children died of tuberculous meningitis and 6 healthy fetuses); as well as 7 fetuses conceived by assisted reproductive technology, 2 abortions, and 5 deliveries (including 3 healthy fetuses and 2 died of tuberculous meningitis). In summary, pregnant women with tuberculosis have a low immune response and more blood-borne disseminated pulmonary tuberculosis. Mycobacterium tuberculosis is prone to cause extrapulmonary tuberculosis by blood dissemination, and tuberculosis meningitis is common. The delay of medical treatment of pregnant women with tuberculosis is serious, and timely and standardized treatment can benefit pregnant women and fetuses.

Key words: Tuberculosis, Pregnancy, Disease attributes