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Case Reports in Pulmonology
Volume 2016, Article ID 3793941, 6 pages
http://dx.doi.org/10.1155/2016/3793941
Case Report

Postpartum Tuberculosis: A Diagnostic and Therapeutic Challenge

1Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA
2Division of Pulmonary Medicine, Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA
3Division of Infectious Diseases, Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA

Received 23 April 2016; Accepted 26 May 2016

Academic Editor: Tun-Chieh Chen

Copyright © 2016 Vijay Kodadhala et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tuberculosis (TB) infection in pregnant women and newborn babies is always challenging. Appropriate treatment is pivotal to curtail morbidity and mortality. TB diagnosis or exposure to active TB can be emotionally distressing to the mother. Circumstances can become more challenging for the physician if the mother’s TB status is unclear. Effective management of TB during pregnancy and the postpartum period requires a multidisciplinary approach including pulmonologist, obstetrician, neonatologist, infectious disease specialist, and TB public health department. Current guidelines recommend primary Isoniazid prophylaxis in TB exposed pregnant women who are immune-suppressed and have chronic medical conditions or obstetric risk factors and close and sustained contact with a patient with infectious TB. Treatment during pregnancy is the same as for the general adult population. Infants born to mothers with active TB at delivery should undergo a complete diagnostic evaluation. Primary Isoniazid prophylaxis for at least twelve weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. This case highlights important aspects for management of TB during the postpartum period which has a higher morbidity. We present a case of a young mother migrating from a developing nation to the USA, who was found to have a positive quantiFERON test associated with multiple cavitary lung lesions and gave birth to a healthy baby.