Airsr NZ J Ohrrer Grnarcol zyxwvutsrqp 1995; zyxwvutsrqpo 35: zyxwvutsrqponm 4: 401 zyxwvutsrqpon OCCASIONAL zyxwvut REVIEW Management Guidelines for M. ~berculosis in Pregnancy Gabrielle R. Casper' and Suzanne M. Garland' Division of Obstetrics and Department zyxwvut of Microbiology, Royal Women k Hospital, Melbourne Summary: Unrecognized M. tuberculosis in pregnancy can have an adverse outcome for women and their babies. With world-wide trends of increasing incidence of M. tuberculosis and increasing migration to Australia of women of childbearing age from countries with a high incidence of this disease, it is imperative that clinicians recognize and be aware of appropriate management of the disease. Management guidelines for M. tuberculosis occumng in pregnancy are outlined. The World Health Organization recently reported that 1 person in 3 of the world's population, some 1700 million people, is infected with M. tuberculosis (TB). Of these, 20 million have active disease, and about zyxwvutsrqp 7,000 people die from it each day (1). Three main reasons have been suggested to account for the recent increase in TB. Firstly, there is con- siderably more migration from countries with a high incidence of tuberculosis to other parts of the world. Secondly, the number of drug-resistant strains of TB is increasing, and these strains are spreading. In Australia, drug-resistance is seen in only 1-2% of Australian-born patients, but in those coming from overseas, particularly from Asia, up to 25% of organisms isolated may be resistant to one or more drugs (2). Thirdly, HIV infection is associated with a high incidence of TB. It is a potent activator of latent TB, and is associated with multiple-drug resistant strains of M. tuberculosis. In January, 1992, it was estimated that 10 million people world-wide were infected with HIV, 34% of these also had tuberculosis (3). In Australia, from 1953 to the mid 1980's, overall there has been a decrease in notifications, although more recently the numbers have plateaued (figure 1). During 1992 there were a total of 1,011 notifications of tuberculosis received, 983 being new cases and 28 reactivations. The highest number of new cases was reported for the 20 to 39 years age group for both sexes. Of the new cases, 224 were women of child- bearing age (figure 2) (4). If Australia follows world 1. Obstetrics Registrar. 2. Director of Microbiology. Address for correspondence: Suzanne M. Garland. Director of Microbiology, Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria, Australia 3053. -1 "= ' YEAR Figure 1. Notification of new cases of tuberculosis per 100,ooO population in Australia, 1948 to 1992, by year (notifications from 1948 to 1985 include atypical disease). Adapted from Hargreaves, 1994 (4). Commonwealth of Australia copyright reproduced with permission. Figure 2. Notification of tuberculosis in Australian women in 1992. Adapted from Hargreaves, 1994 (4). Commonwealth of Australia copyright reproduced with permission. trends, a rise could be expected soon. Consequently those dealing with antenatal patients need to be alert to the possibility of TB and have an understanding of management in such patients.