SPECIAL CONDITIONS

Pregnancy and TB

• If TB is diagnosed during pregnancy, a complete treatment with anti-TB drugs should be given in consultation with the physician. If pregnancy occurs during the treatment, the patient must continue the therapy with drugs which are safe in pregnancy and should not terminate the pregnancy.

• Streptomycin injections are contraindicated in pregnancy. 

• Avoid getting any X-rays / exposure to radiation and use abdominal shields if they are necessary.

• The newborn should not be separated from the mother with TB. The child should be breast fed with proper precautions like the mother covering her mouth and maintaining cough discipline.

• BCG should be given to the child at birth and should be evaluated for chemoprophylaxis by the physician. 

• A female TB patient should avoid getting pregnant for one year or at least till she completes her treatment.

HIV and TB

• HIV is transmitted by three routes :
  

  • Sexual contact

  • Blood transfusion / needles

  • Mother to child

• The rise in the HIV cases in the world as well as in India, has greatly increased the incidence of TB. 

• HIV infection weakens the immune (defense) system of the body thereby increasing the risk of the HIV infected individual to contract TB. It is estimated that an HIV positive patient has a 60% life time risk of developing TB in contrast to HIV negative individuals  with a 5-10 % risk of developing TB. India is estimated to have around 3.5 million HIV patients, out of which about 1.8 million patients are co-infected with TB.

• In a patient who has HIV and TB co-infection, TB may allow HIV organisms to multiply more rapidly, resulting in a quick progression of HIV infection to development of AIDS.

• HIV patients are more prone to get disseminated and extra-pulmonary TB, depending upon the decrease in their immune system. 

• Several other diseases may mimic TB in HIV positive individuals, these include:
  

  • Bacterial pneumonia

  • Pneumocystis carinii pneumonia 

  • Kaposi's sarcoma

  • Fungal infection of the lungs

• Common presentations of extra-pulmonary TB in HIV patients are :

  • Lymph node enlargement

  • Fluid accumulation in lung cavity

  • Meningitis

• Response to treatment is similar in HIV positive patients as compared to HIV negative individuals.

• Adverse drug reactions are more common in HIV positive patients, with the risk of drug reaction increasing with decrease in immunity.

• Skin rash is the commonest reaction.

• Thiacetazone is contraindicated in HIV patients, as it can lead to serious skin rashes and a life threatening condition (Steven Johnson syndrome).

• Streptomycin is also avoided in TB patients with HIV, as HIV may spread in the community by use of non-disposable needles (a practice which is widespread in India).

Diabetes and TB

• Diabetic patients are more prone to develop TB.

• If the TB patient is above the age of 45 years, he should be investigated for blood and urine sugar to rule out diabetes.

• Any atypical presentation of TB or a relapse of TB warrants investigations for diabetes.

• TB in diabetics is more severe in nature and does not respond well to treatment unless the diabetes is well- controlled.

• Diabetes should be controlled with insulin, as Rifampicin can decrease the efficacy of oral anti-diabetic drugs.

• Your physician is the best judge for any alterations in the therapy.