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TB in Pregnancy — SCE Infectious Diseases MCQ

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ModerateTuberculosisTB in PregnancySCE Infectious Diseases

A 30-year-old woman from Somalia presents with a 3-month history of cervical lymphadenopathy. FNA shows granulomatous inflammation but is AFB-negative. TB culture is pending. IGRA is positive. Chest X-ray is normal. She is 14 weeks pregnant. Should anti-TB treatment be started empirically?

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Correct answer: D — Yes; start standard RHZE while awaiting culture — TB lymphadenitis in pregnancy should not await culture confirmation if clinical suspicion is high

In a high-prevalence population with clinical and cytological features consistent with TB lymphadenitis and positive IGRA, empirical anti-TB treatment should be started while awaiting culture results. Untreated TB in pregnancy carries significant risks to both mother and fetus (preterm birth, low birth weight, maternal mortality). Standard first-line therapy (RHZE) is recommended in pregnancy — all four drugs are safe. Streptomycin is the only first-line drug contraindicated (ototoxicity to fetus). Pyridoxine should be co-prescribed.

Reference: NICE NG33 2016 – TB; BHIVA 2025 – HIV in pregnancy (TB section applies to all pregnant women)