Frontal lobe tuberculoma masquerading as postnatal depression

HIV/Tuberculosis Coinfection in Pregnancy and the Postpartum Period

The convergence of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) represents a considerable global public health challenge. The concurrent infection of HIV and TB in pregnant women not only intensifies the transmission of HIV from mother to fetus but also engenders adverse outcomes for maternal health, pregnancy, and infant well-being, necessitating the implementation of integrated strategies to effectively address and manage both diseases. In this article, we review the pathophysiology, clinical presentation, treatment, and management of HIV/TB coinfection during pregnancy, the postpartum period, and lactation and highlight the differences compared to the general population.

Case report: Depressive disorder with peripartum onset camouflages suspected intracranial tuberculoma

BACKGROUND

Co-occuring psychological symptoms and rare medical illnesses like intracranial tuberculoma add difficulties in diagnosing and treatment. The present report discussed a rare case of a young woman with tuberculoma and depressive disorder with peripartum onset.

CASE PRESENTATION

The patient was a 22-year-old woman. She underwent a cesarean section due to premature rupture of the membrane. She had developed behavioral changes for 3 months before admission and had been brought to general practitioner for several times during pregnancy. Her symptoms worsen after she underwent a cesarean section. She refused to answer doctor's and family's questions and she showed symptoms of depression. She was diagnosed with depressive disorder with peripartum onset and treated according to her diagnosis. However, she also experienced intermittent headaches which lead to suspicion that there was an organic cause for her complaints. Computed tomography (CT) was done and revealed suspected intracranial tuberculoma and meningitis. She died due to respiratory distress before she got adequate treatment for her illnesses.

CONCLUSION

The possibility of neurocognitive disorder due to infection such as intracranial tuberculoma should be considered as an additional diagnosis (co-occuring disease) or differential diagnosis in people who develop psychiatric symptoms, especially in areas with high tuberculosis incidence.

Systematic Review and Meta-Analysis of the Prevalence of the Maternity Blues in the Postpartum Period

OBJECTIVE

To determine the prevalence of maternity blues among women in the postpartum period.

DATA SOURCES

We conducted our systematic review and meta-analysis by searching the literature for relevant articles published in three international databases, PubMed, Web of Science, and Scopus, from date of inception through December 11, 2019, using the keywords prevalence, incidence, maternity blues, and baby blues.

STUDY SELECTION

From 336 articles initially screened, we included 26 articles in the systematic review and meta-analysis.

DATA EXTRACTION

Two independent reviewers used a standardized form to extract data from eligible articles. We evaluated the quality of individual studies and the overall evidence according to Hoy et al.'s risk of bias tool.

DATA SYNTHESIS

The prevalence of maternity blues in the 26 included studies was 13.7% to 76.0%. Based on the results of the random effects model, the prevalence of maternity blues in 5,667 women was 39.0% (95% confidence interval [32.3, 45.6]; I² = 96.6%). The prevalence of maternity blues among women in Africa was greatest at 49.6%.

CONCLUSION

Considering the great prevalence of maternity blues in women after childbirth, paying attention to the key symptoms of maternity blues and implementing educational programs for health care providers and mothers after childbirth are essential.

Postpartum psychiatric disorders: Early diagnosis and management

Postpartum period is demanding period characterized by overwhelming biological, physical, social, and emotional changes. It requires significant personal and interpersonal adaptation, especially in case of primigravida. Pregnant women and their families have lots of aspirations from the postpartum period, which is colored by the joyful arrival of a new baby. Unfortunately, women in the postpartum period can be vulnerable to a range of psychiatric disorders like postpartum blues, depression, and psychosis. Perinatal mental illness is largely under-diagnosed and can have far reaching ramifications for both the mother and the infant. Early screening, diagnosis, and management are very important and must be considered as mandatory part of postpartum care.

A review of the interplay between tuberculosis and mental health

AIMS

Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/substance abuse and migrant status leading to frequent comorbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.

METHODS

A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. In total 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.

RESULTS

Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses, such as depression, may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects and some medications such as rifampicin may reduce the effective doses of anti-psychotics y their enzyme induction actions. Treatment with agents such as cycloserine has been associated with depression, and there have been reported cases of psychosis with most anti-tuberculous agents. Mental illness and substance abuse may also affect compliance with treatment, with attendant public health concerns.

CONCLUSIONS

As a result of the common co-morbidity of mental illness and tuberculosis, it is probable that physicians will encounter previously undiagnosed mental illness among patients with tuberculosis. Similarly, psychiatrists are likely to meet tuberculosis among their patients. It is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.

Immune reconstitution syndrome and exacerbation of infections after pregnancy

Pregnancy is a state of subtle immunosuppression characterized by physiologic suppression of proinflammatory host responses that are meant to promote embryonic implantation. Rapid reversal of these changes and a rebound of inflammatory responses during the postpartum period can result in quiescent or latent infection manifesting as symptomatic disease. Infections due to several microbial pathogens and noninfectious diseases with an autoimmune basis have been shown to worsen or begin during the postpartum period. Awareness that symptoms resulting from immune reconstitution can occur in any host with a rapidly changing immunologic repertoire, including women in the postpartum phase, is a critical first step in fully understanding this phenomenon. Future studies to discern the precise pathophysiologic basis of immune reconstitution, to identify pregnant women at risk, and to determine markers that may be diagnostically helpful have significant implications for optimizing treatment of these patients.