Does my wife need treatment for tuberculosis during pregnancy?
Q: My 34 years old wife is three months pregnant. This is her second pregnancy. Her last pregnancy (3 years back) led to a missed abortion in the 12th week of gestation. Hence the doctor has now put her on progesterone therapy once in 15 days for the past one month. One and half months back, enlargement of cervical and auxiliary lymph nodes were noticed. The gynaecologist referred her to a physician. He physically examined her and asked for a Mantoux test. Her ESR was 42 mm at 1 hour (previously when checked by the gynaecologist during first month of gestation it was 28 mm at 1 hour). The physician after seeing the ESR and PPD came to the conclusion that my wife was affected with tuberculosis (TB). She had no other symptoms of TB. He prescribed Forecox 2 tablets daily each containing Isoniazid (225 mg), Rifampicin (150 mg), Ethambutol (400 mg) and Pyrazinamide (750 mg). I have read that isoniazid, rifampicin, ethambutol is safe during pregnancy and poses no teratogenic problem. But with respect to pyrazinamide, literature gives little information regarding its safety and some say it is not recommended. My wife has started taking tuberculosis therapy since last two days. What are the side effects of this therapy? Please advise.
A:There are several issues that need attention:
- ESR is not diagnostic of tuberculosis at all,
- Mantoux is indicative but not fully diagnostic.
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