The course of pregnancy and relapse of tuberculosis after COVID-19

Abstract

The own observation of pregnancy and tuberculosis after COVID-19 in a patient who was treated in the pulmonary tuberculosis department N 2 of the Zaporizhia Regional Phthisiopulmonology Clinical Medical Diagnostic Center is presented. According to the presented clinical case, a woman, who had pulmonary tuberculosis 9 years ago, underwent mild COVID-19 at the 20th week of pregnancy and did not receive any treatment. The patient had of the dispensary observation in the phthisiatrician and regularly underwent preventive check-­up, because of her previous tuberculosis. However, the patient was hospitalized in the intensive care unit of the PNE «Regional Perinatal Center» ZRC with moderate preeclampsia, signs of intrauterine fetal hypoxia, in which the mother needed medical care, at the 32nd week of pregnancy. Three days after hospitalization, in view of the fetal distress and preeclampsia, it was made a decision to perform assisted delivery by cesarean section. The child was born alive, vertical transmission of COVID-19 was not diagnosed. Taking into account the history of tuberculosis in anamnesis, the woman underwent X-­ray examination of the thoracic cavity organs, where the reactivation of a specific process, on the background of metatuberculous changes, were revealed. The woman was diagnosed of multidrug­-resistant tuberculosis (MDR-­TB) with a destructive process in the lungs by further examination, that’s why, she was hospitalized to Zaporizhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology» of Zaporizhia Regional Council for further treatment. A course of antimycobacterial therapy (AMBT), according to the modified short­-term treatment regimen, was prescribed to the patient. Against the background of AMBT, rapid positive dynamics was determined: stable cessation of bacterial excretion was determined after 1 month of AMBT, and healing of destruction with the formation of residual post-­tuberculosis changes — after 2 months. The presented clinical case demonstrates the negative impact of COVID-19 both on the course of pregnancy (moderate preeclampsia, which led to cesarean section at 32nd weeks of pregnancy) and on the reactivation of the tuberculous process, with its course in the form of MDR­-TB.