Ir ad y k r ,, 11

1 tr n al r nJ 11

d n ,.1l1v l l•f•f J
If h e r t n 1 ill r sd y k1 ''Wn
reacti.on
· · cti r d m n hould ht: prr1t· 1 ,,
h aYe a po 1 1 \e rea
bv a lead h1eld .,., hile a che t rac.110graph i takc11, pr ·h.ii,
after the fir t tnmester. D1agnc J t: C<Jn firn1cd liy l'><il.111
.d t·r.;ng the bacterium in the sputum.
and 1 en i.1 I I· r ·
ign and ymptoms include g<:nera ma aJS(;, 1<it1guc, Ir, .
· . ght Jo 5• and fever. Sympt<J.ms <Jccu .r i n the Id
of appeti te, \\ el
afternoon and evening and are accompanied by n ight we;41
As the disea e progresses, a chronic wugh devcl<Jp Mid
mucopurulent sputum i produced. ..
TB increases with poverty, maln utntJ(Jn, and HI V infoc
tion. Worldwide, it is responsible for more deaths than an,
other communicable disease. The incidence is increa<;ing in
inner-city areas and among homeless perso_ns. ft is also prc:vd
lent among immigrants from Southeast Asia and Central and
South America.
fetal and Neonatal Effects. Although perinatal infectum
is uncommon, it may be acquired as a result of the fotu
swallowing or aspirating infected amniotic fluid. Diagnosi
made by finding the bacilli in the gastric aspirate of the neonate
or in placental tissue. Signs of congenital TB include failure Ill
thrive, lethargy, respiratory distress, fever, and enlargement
of the spleen, liver, and lymph nodes. If the mother remains
untreated, the newborn is at high risk for acquiring TB by
inhalation of infectious respiratory droplets from the mother.
Therapeutic Management. Untreated TB poses a greater
hazard to the fetus than its treatment (CDC,2016i). Treatmen
of TB is based on two principles. First, more than one drug
should be used to prevent the growth of resistant organisms.
Second, treatment should continue for a prolonged period
The preferred treatment for pregnant women with active TB
is isoniazid (I H), rifampin (RIF), and ethambutol (EMB
daily for 2 months, followed by I H and RIF daily or twice
weekly for 7 months, for 9 months of total treatment duration.
Pyridoxine (vitamin B6) should be given with isoniazid t
prevent fetal neurotoxicity and because pregnancy itseli
increases the demand for this vitamin. Drug resistance in the
TB organism may require addition of other drugs, although
the following drugs are not recommended in pregn an0·
streptomycin, kanamycin, capreomycin, ethionantide
cycloserine, pyrazinamide, amikacin, and tluoroquinolones
(CDC, 2016i; Whitty & Dombrowski, 2017).
Management of the infant born to a mother with TB
involves preventing the disease and treating the infectioll
early. If the mother's sputum is free of organisms, the infa.Jll
oes not need to be isolated from the mother. Breastfeedifl
IS safe, and drugs may be secreted in breast milk. Ho·e,-
er. the maternal antituberculosis drugs in breast milk are
ool dequate for infant treatment. Drug serum level in
_int
t can be measured to identify if levels are too h 18ti.
!Sease.prevention focuses on teaching the mother .;.id
the family how the disease is tran mitted 0 that the}'
protect the infant and other family members from
airborfl' organl ms. The infant hould be skin-tested at
birth and fll3'