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DOI: 10.1055/a-0774-7924
Tuberkulose in der Schwangerschaft – eine Übersicht
Article in several languages: English | deutschPublication History
received 26 July 2018
revised 23 October 2018
accepted 23 October 2018
Publication Date:
08 January 2019 (online)
![](https://www.thieme-connect.de/media/gebfra/201904/lookinside/thumbnails/10-1055-a-0774-7924_gf_de-1.jpg)
Zusammenfassung
In den letzten Jahren hat die Inzidenz der Tuberkulose in der Schwangerschaft in den Industrienationen zugenommen. Eine Tuberkulose in der Schwangerschaft ist mit einem erhöhten Risiko für Mutter und Kind verbunden. Auch wenn für Deutschland keine Zahlen existieren, ist aufgrund der Migrationsbewegungen von einer Zunahme von Tuberkuloseerkrankungen unter Schwangeren auszugehen, so zeigen auch aktuelle Daten aus den USA eine steigende Tuberkuloseinzidenz bei Schwangeren in den letzten Jahren. Die durch eine Schwangerschaft bedingten physiologischen und immunologischen Veränderungen haben dabei wahrscheinlich einen negativen Einfluss auf den Krankheitsverlauf und können die Diagnosestellung erschweren. Zur Diagnostik der latenten tuberkulösen Infektion gibt es international keine einheitlichen Empfehlungen. Wenn ein Screening in spezifischen Risikopopulationen erfolgt, sollte nach der gegenwärtigen Studienlage hierbei prioritär ein Interferon-γ Release Assay (IGRA) zum Einsatz kommen. Sowohl bei entsprechender Symptomatik als auch bei einem positiven IGRA-Test ist auch in der Schwangerschaft eine weiterführende Diagnostik indiziert. Im Falle einer Tuberkulose darf die Tatsache des Vorliegens einer Schwangerschaft die Einleitung einer antituberkulösen Therapie nicht verzögern, da deren frühzeitiger Beginn mit einem günstigeren Outcome für Mutter und Kind assoziiert ist. Die gängigen Erstlinientherapeutika können auch in der Schwangerschaft zur Anwendung kommen und werden als sicher angesehen. Die Therapie einer latenten tuberkulösen Infektion in der Schwangerschaft ist umstritten.
Schlüsselwörter
Infektionen - Schwangerschaft - Tuberkulose - immunologische Veränderungen - Epidemiologie - Therapie* BW und MK haben zu gleichen Teilen beigetragen.
** AvB und HS haben zu gleichen Teilen beigetragen.
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