Pregnancy Outcome in Newly Diagnosed Tuberculosis in the Second Trimester: Case Report

An estimated 1.7 billion people are infected with the tuberculosis bacillus and are therefore at risk of developing tuberculosis. Globally, until the SarsCo-V2 pandemic, tuberculosis was the most common cause of infectious disease-related death. For women infected with Mycobacterium tuberculosis, pregnancy is associated with an increased risk of developing or worsening tuberculosis. In some endemic areas, tuberculosis is an important cause of maternal mortality and morbidity and is associated with higher rates of preterm birth, low birth weight, and fetal death. In some studies, stillbirth and neonatal death were more common in patients with latent tuberculosis compared to uninfected patients, but no statistically significant difference was demonstrated. It has long been known that untreated tuberculosis poses a far greater danger to the pregnant woman and the fetus than the treatment of the disease, so early detection and treatment of tuberculosis in pregnancy is of key importance for reducing the aforementioned risks. The first case is a 37-year-old patient in the 24th week of pregnancy, achieved by in vitro fertilization. Due to the poor general condition and swelling of the amniotic fluid, the pregnancy was terminated by caesarean section. Further worsening of the clinical picture in the direction of an acute infection of the central nervous system, with the development of neurological symptoms. After radiological, microbiological and cytological processing, continuation of treatment of tuberculosis infection.The second case is a 24-year-old pregnant woman in the 20th week of pregnancy, febrile with a dry cough and elevated inflammation parameters. On the 14th day of hospitalization, a wider diagnostic test was performed. Sputum on BK was negative, Quantiferon test was negative. Low-dose CT of the chest described bilateral lung infiltration and right-sided pleural effusion with subpleural nodules. On the 25th day of hospitalization due to the progression of the right-sided pleural effusion, the thoracic surgeon indicated VATS operative intervention. Pathohistological analysis confirmed that it was chronic granulomatous inflammation of the tuberculosis type.In our two cases, the diagnostic and therapeutic approach and the outcome of the pregnancy are shown and the condition of the neonate. Both cases are in the second trimester of pregnancy, with difficult diagnosis due to negative tests for tuberculosis infection. The neonatal outcome of both pregnancies was poor.