{"id":2606,"date":"2026-06-30T14:20:05","date_gmt":"2026-06-30T09:20:05","guid":{"rendered":"https:\/\/journal.nncf.kz\/?p=2606"},"modified":"2026-07-03T23:29:30","modified_gmt":"2026-07-03T18:29:30","slug":"%d1%81%d0%bb%d0%be%d0%b6%d0%bd%d0%be%d1%81%d1%82%d0%b8-%d0%b4%d0%b8%d0%b0%d0%b3%d0%bd%d0%be%d1%81%d1%82%d0%b8%d0%ba%d0%b8-%d1%82%d1%83%d0%b1%d0%b5%d1%80%d0%ba%d1%83%d0%bb%d0%b5%d0%b7%d0%bd%d0%be%d0%b3","status":"publish","type":"post","link":"https:\/\/journal.nncf.kz\/en\/%d1%81%d0%bb%d0%be%d0%b6%d0%bd%d0%be%d1%81%d1%82%d0%b8-%d0%b4%d0%b8%d0%b0%d0%b3%d0%bd%d0%be%d1%81%d1%82%d0%b8%d0%ba%d0%b8-%d1%82%d1%83%d0%b1%d0%b5%d1%80%d0%ba%d1%83%d0%bb%d0%b5%d0%b7%d0%bd%d0%be%d0%b3\/","title":{"rendered":"DIAGNOSTIC CHALLENGES OF TUBERCULOUS PLEURISY DURING PREGNANCY (a clinical case)"},"content":{"rendered":"

Received by the Editorial Office: 13.04.2026<\/em><\/p>\n

Accepted for publication: 16.05.2026<\/em><\/p>\n

Published online: 30.06.2026<\/em><\/p>\n

UDC: 618.2:616.25-002.5<\/p>\n

DOI: 10.26212\/2227-1937.2026.29.95.008<\/a><\/p>\n

 <\/p>\n

DIAGNOSTIC CHALLENGES OF TUBERCULOUS PLEURISY DURING PREGNANCY (a clinical case)<\/strong><\/p>\n

 <\/p>\n

Bishchekova B.N.\u00b9, Kozhabekova T.A.\u00b9, Ali G.A.\u00b9, Shukirbayeva A.S.\u00b9, Bektas A.Zh.\u00b9, Sailau Zh.Zh.\u00b9, Uksikbay K.Zh.\u00b9
\n<\/strong>1<\/sup><\/em>Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan<\/em><\/p>\n

 <\/p>\n

Introduction. <\/strong>Tuberculosis (TB) during pregnancy is a serious problem for phthisiologists, obstetricians, and gynecologists. At this stage, immune adaptation (a decrease in the activity of T-lymphocytes), aimed at preserving the fetus, can lead to an activation or atypical course of the tuberculosis process. Although pleural tuberculosis is the most common form of extrapulmonary tuberculosis, in pregnant women, its clinical picture is often nonspecific. The novelty and practical value of this article lie in\u00a0 it\u2019s showing ways to detect the etiology of pleurisy in pregnant women without specific symptoms early using modern immunological (QuantiFERON) and molecular genetic (GeneXpert) methods.<\/p>\n

Description of the clinical case. <\/strong>Patient D., 33 years old, first pregnancy, was admitted to the hospital at 37 weeks with complaints of nasal congestion, dry cough, shortness of breath, and general weakness. During the initial clinical evaluation, the patient was diagnosed with acute respiratory viral infections and tracheobronchitis. During an in-depth medical history examination, it was established that the patient was in close contact with a sister with tuberculosis. During the physical examination, body temperature was 37.5 \u00b0C oxygen and saturation was 96%.<\/p>\n

Diagnostic assessment. <\/strong>To clarify the diagnosis, a comprehensive study was conducted. Radiation diagnosis: chest X-ray and ultrasound revealed a left-sided hydrothorax. Computed tomography (CT) showed a picture of left-sided baggy pleurisy and chronic bronchitis. Microbiological examination: the results of bacterioscopic and molecular genetic (GeneXpert) sputum examination were negative. Immunological diagnosis: the main suspicion of the tuberculosis process arose after a positive test result for QuantiFERON. Invasive diagnosis: a pleural puncture was performed, and 975 ml of serous fluid was obtained. A GeneXpert MTB\/RIF examination of the fluid revealed Mycobacterium tuberculosis DNA, and the diagnosis was definitively proven.<\/p>\n

Tactics of treatment and delivery.<\/strong> By the decision of the consultation, the patient was prescribed complex (antibacterial, hormonal, and expectorant) therapy. The use of vacuum extraction for labor induction (oxytocin) at 38 weeks was chosen as an obstetric tactic.<\/p>\n

Outcomes and observation. <\/strong>A live boy weighing 3822 g, 7-8 points on the Apgar scale, was born. After the stabilization of the mother’s condition on the third day after giving birth, she was transferred to the National Scientific Center of Phthisiopulmonology to receive specific treatment.<\/p>\n

Discussion. <\/strong>This condition indicates a “disguised” course of tuberculous pleurisy during pregnancy. The main diagnostic problem is the absence of mycobacteria in sputum and the similarity of the clinical signs to those of simple bronchitis. Although CT and ultrasound revealed pleural fluid , the QuantiFERON test and GeneXpert pleural fluid analysis were crucial in clarifying the etiology. This proves the importance of an interdisciplinary approach.<\/p>\n

Conclusion.<\/strong> Pleurisy that develops during pregnancy requires high clinical caution on the part of phthisiopulmonologists and midwives. With the low sensitivity of microbiological studies, molecular genetic examination of pleural fluid anables a timely diagnosis and a favorable perinatal outcome for mother and child.<\/p>\n

Key words: <\/strong>tuberculosis, pleurisy, pregnancy, QuantiFERON, GeneXpert, childbirth.<\/p>\n

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