{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:40:47Z","timestamp":1788932447348,"version":"build-2803163510"},"reference-count":89,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"crossref","award":["K23NS110470"],"award-info":[{"award-number":["K23NS110470"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"crossref","award":["R01NS086312)"],"award-info":[{"award-number":["R01NS086312)"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["R01AI162786"],"award-info":[{"award-number":["R01AI162786"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Academic Clinical Lectureship","award":["CL-2020-27-001"],"award-info":[{"award-number":["CL-2020-27-001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tuberculosis is a leading cause of death among women of reproductive age. However, tuberculous meningitis, the most severe form of extrapulmonary tuberculosis, is rarely discussed in pregnancy despite this being a unique period of immune modulation that may predispose women to active disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We identified and described cases of tuberculous meningitis among pregnant or postpartum women screened during meningitis clinical trials in Uganda from 2018 to 2022. We conducted a systematic literature review via PubMed\/Medline and Embase for all English-language publications from 1970 to 10 July 2022, to identify additional cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 8 cases of pregnancy-related tuberculous meningitis in Ugandan women living with human immunodeficiency virus (HIV) and 40 additional cases via systematic literature review (none HIV-positive). Of all combined cases, 50% (24\/48) were diagnosed postpartum; 50% (24\/48) had initial onset during pregnancy, of which 38% (9\/24) had worsening of symptoms or disease relapse following pregnancy cessation. Diagnosis was missed or delayed in 33% (16\/48) of cases. For those with known outcomes, maternal mortality was 23% (11\/48) and fetal\/neonatal mortality was 30% (13\/44). Of maternal survivors, 30% (11\/37) had residual neurologic deficits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The true incidence of tuberculous meningitis in pregnancy or the postpartum period is unclear but likely underappreciated. To date, nearly all published cases have occurred in HIV-negative or otherwise immunocompetent women. Given the well-described physiological immunosuppression during pregnancy and subsequent reconstitution postpartum, physicians must be aware of tuberculous meningitis and pregnancy-related immune reconstitution inflammatory syndrome, especially in countries with a high burden of tuberculosis and in women living with HIV.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofac513","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T12:20:04Z","timestamp":1665058804000},"source":"Crossref","is-referenced-by-count":7,"title":["Pregnancy-Related Tuberculous Meningitis and Immune Reconstitution Inflammatory Syndrome: A Case Series and Systematic Review"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1306-1713","authenticated-orcid":false,"given":"Katelyn A","family":"Pastick","sequence":"first","affiliation":[{"name":"Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts , 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Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-4887","authenticated-orcid":false,"given":"Jane","family":"Gakuru","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3464-6577","authenticated-orcid":false,"given":"Jack","family":"Milln","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Queen Charlotte's and Chelsea Hospital , London , United Kingdom"},{"name":"Medical Research Council\/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4953-8974","authenticated-orcid":false,"given":"Betty","family":"Nakabuye","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Uganda Martyrs Hospital Lubaga , Kampala , Uganda"},{"name":"School of Public Health, Makerere University College of Health Sciences , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8854-0321","authenticated-orcid":false,"given":"David B","family":"Meya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4715-0060","authenticated-orcid":false,"given":"David R","family":"Boulware","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5070-532X","authenticated-orcid":false,"given":"Fiona V","family":"Cresswell","sequence":"additional","affiliation":[{"name":"Medical 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