Tuberculosis diagnosed during pregnancy: a prospective study from London

Background-A study was undertaken to characterise the presentation of tuber culosis in pregnancy and the difficulties in diagnosis in an area of the UK with a high incidence of tuberculosis. Methods-A prospective case series was investigated at Northwick Park Hospit al, a university affiliated district general hospital in Brent and Harrow h ealth authority in north-west London which incorporates a regional infectio us diseases unit. Patients diagnosed with tuberculosis over the study perio d were included if the onset of symptoms occurred during pregnancy. Results-Thirteen patients were diagnosed during a 30 month period from Dece mber 1995 to May 1998 during which 9069 mothers were delivered, a prevalenc e of 143.3/100000 deliveries. Symptoms began at a median of 22 weeks gestat ion (range 9-40 weeks). All patients were recent immigrants of Indian subco ntinent or Somali origin and their median duration of residence in the UK w as 31 months (range 1-72). Prevalence broken down for racial origin of moth ers was 466.3/100000 for mothers of black African origin and 239.1/100000 f or mothers of Indian origin. Nine of the 13 patients had extrapulmonary tub erculosis. Four patients with widely disseminated disease had a negative Ma ntoux response and five with localised disease had a strongly positive Mant oux response. HIV co-infection was absent. The median delay between the ons et of symptoms and diagnosis was seven weeks (range 2-30). The response to standard treatment was excellent and all patients were cured. Conclusions-Tuberculosis occurring in pregnancy is common in recent immigra nts. Diagnosis during pregnancy is delayed because the disease is frequentl y extrapulmonary with few symptoms.