Abstract:

Objective To investigate the clinical characteristics of patients with tuberculous meningitis after pregnancy undergoing in vitro fertilization and embryo transplantation.Methods The clinical data of 15 patients with tuberculous meningitis (15 patients underwent routine pulmonary CT scan and tuberculin tests before the operation to exclude active tuberculosis) after pregnancy undergoing in vitro fertilization-embryo transfer treated in the Department of Tuberculosis of the Shenyang Tenth People’s Hospital from May 2014 to May 2019 were retrospectively analyzed. Including general conditions, clinical manifestations, signs, enhanced brain MR scan and tuberculin test, T-cell spot test for blood tuberculosis infection (T-SPOT.TB), tuberculosis antibodies, AFP, CD4 ⁺/CD8 ⁺, cerebrospinal fluid (CSF) tuberculosis culture, CSF rifampicin resistance real-time quantitative nucleic acid amplification detection technology (GeneXpert MTB/RIF), CSF loop-mediated isothermal amplification (LAMP) to summarize the clinical characteristics.Results Fourteen of 15 patients had fever, including 3 cases with high fever (39.1-41.0℃), 9 with moderate fever (38.1-39.0℃) and 2 with low fever (37.3-38.0℃). Among the 15 patients, 6 cases had hematogenous disseminated tuberculosis, 2 cases had concurrent hematogenous disseminated tuberculosis and tuberculous pleurisy, 1 case had concurrent hematogenous disseminated tuberculosis and secondary pulmonary tuberculosis, and 3 cases had secondary pulmonary tuberculosis, 1 case had tuberculous pleurisy, and 1 case had concurrent secondary pulmonary tuberculosis and tuberculous pleurisy. Among the 15 patients, 14 patients underwent enhanced cranial MR scans, and 12 patients were abnormal. The main manifestations were: The bilateral brain, cerebellum and brain stem had long T₁ and T₂ signals, and there were multiple intracranial enhancement nodules; 15 cases underwent skin tuberculin test, 6 cases were strongly positive; 15 cases T-SPOT.TB test, 14 cases were positive; 15 cases were tested for tuberculosis antibody, 9 cases were positive; 10 cases were underwent CSF GeneXpert MTB/RIF test, 2 cases were positive in which 1 case with a negative MGIT 960 culture; 15 patients underwent MGIT 960 culture and 4 were positive; 10 of 15 patients underwent abortion in the first and second trimester, 1 had a normal delivery and 4 had cesarean section in the late pregnancy. Of the 5 babies born, 1 died of congenital tuberculosis after birth in nearly one month, and the remaining 4 infants were healthy. Of the 15 patients, 5 had hypokalemia and 6 had anemia; 5 had abnormal liver function and 5 had hyperuricemia after anti-tuberculosis treatment. The average treatment time for the patient’s CSF pressure to return to the normal value below 180 mm H₂O (1 mm H₂O=0.0098 kPa) was (22.4±20.5) d. And the average treatment time for fluid indicators (CSF protein, glucose, chloride, and cell numbers) to return to normal was (70.8±74.0) d; After active anti-tuberculosis treatment, 14 patients were cured and 1 patient died.Conclusion Patients with tuberculous meningitis after pregnancy undergoing in vitro fertilization-embryo transfer usually have fever symptoms, concurrent with hematogenous disseminated tuberculosis, high positive rate of peripheral blood T-SPOT.TB test, low positive rate of CSF etiology and a long time for CSF pressure to return to normal.

Key words: Fertilization in vitro, Embryo transfer, Tuberculosis,meningeal, Pregnancy complications,infectious, Disease attributes