[Tuberculosis in pregnancy and puerperium]

According to the World HeaLth Organization, tuberculosis (TB) is the third leading cause of death worldwide among women at child bearing age. However, in Israel, a low TB prevalence country, TB in pregnant women is infrequent and infectious pulmonary TB at puerperium is rare. Early diagnosis of TB in pregnancy is challenging because the non-specific symptoms of early TB such as weakness, excess perspiration and tachycardia will usually be attributed to pregnancy. Furthermore, since health care givers attempt to avoid superfluous exposure of the fetus to radiation, and pregnant women are reluctant to be X-rayed, the diagnosis of active TB may be further delayed, especially if the woman is not in a risk group for TB. However, delaying treatment of TB in a pregnant woman, especially in advanced pregnancy may lead to TB in the fetus, TB infection of the new born transmitted from the mother who may also infect other mothers and their infants in the maternity ward. We report a case of highly infectious active TB diagnosed in a pregnant woman one week before delivery. The woman, a native Israeli, had no risk factor for TB except her recent stay in a high burden TB country. We present the diagnostic workup and therapeutic approach to the pregnant patient, the newborn infant and the measures applied to control infection. Awareness of risk factors for TB, the elusive symptoms of the disease during pregnancy, and implementing the necessary diagnostic workup at delivery is vital to minimize pregnancy related TB morbidity.