AUTHOR=Dong Siyuan , Zhou Ruoyu , Peng Emin , He Ruoxi 

TITLE=Analysis of Clinical Features and Risk Factors in Pregnant Women With Miliary Pulmonary Tuberculosis After In Vitro Fertilization Embryo Transfer

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.885865

DOI=10.3389/fcimb.2022.885865

ISSN=2235-2988

ABSTRACT=Purpose: Miliary pulmonary tuberculosis (TB) among pregnant women after in vitro fertilization embryo transfer (IVF-ET) cause poor outcomes but are rare reported. This study analyzed the clinical characteristics and risk factors of these patients to provide hints to further studies. 
Method: The demographics characteristics, clinical manifestations, radiologic features, treatment and outcomes of 6 patients diagnosed from May 2012 to August 2021 in our hospital and 69 patients that were reported in English or Chinese literatures from January 1980 to August 2021 were retrospectively analyzed. Continuous variables were compared between groups by t-test, and categorical variable were compared between groups by chi square test or Fisher exact test. Multiple logistic regression analysis was used to determine predictors of respiratory failure. 
Results: A total of 75 patients were included. The average age of patients was about 30 years old. All patients had tubal obstruction; 5 of them were diagnosed as pelvic TB before. Thirteen cases had history of pulmonary or extrapulmonary TB, 6 out of them without any antituberculosis treatment. The average interval between onset of symptoms and radiologic examination was 21 days. Forty-four out of 67 patients underwent chest X-ray, 12 of them clearly displayed pulmonary miliary nodules. The most common abnormalities on chest computed tomography scan were multiple nodules, pulmonary infiltrate or consolidation. Merely 10 patients obtained microbiological diagnosed by Mycobacterium tuberculosis culture or polymerase chain reaction test. The other patients were clinical diagnosed. All cases were cured after antituberculosis treatment, but only 8 fetuses survived (10.6%). The most frequent and severe complication was typeⅠrespiratory failure (20%). Patients with expectoration, dyspnoea, coarse breath sounds, ground-glass opacity, and pulmonary infiltrate or consolidation were more likely to have respiratory failure (P<0.05). Ground-glass opacity (OR=48.545, 95%CI=2.366-995.974, P=0.012) and pulmonary infiltrate or consolidation (OR=19.943, 95%CI=2.159-184.213, P=0.008) were independent predictors for respiratory failure.
Conclusion: Tube infertility with underscreened or untreated TB are risk factors for miliary TB during pregnancy after IVF-ET. Ground-glass opacity and pulmonary infiltrate or consolidation are predictors for respiratory failure. We demonstrate risk factors for incidence and complications in order to supply clues for future intervention and improve patient prognosis.