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Viral and Protozoal Infection in Pregnancy
Viral and Protozoal Infection in Pregnancy
pregnancy
Viral infection
CYTOMEGALOVIRUS
CHICKENPOX PARVOVIRUS
(CMV)
HERPES SIMPLEX
MUMPS HIV
VIRUS (HSV)
RUBELLA
• Rubella or German measles (RNA virus) is
transmitted by respiratory droplet exposure.
• Maternal Rubella features
i. Rash
ii. Malaise
iii. Fever
iv. lymphadenopathy
v. Polyarthritis
(CRS)
Management
• specific antibody (IgM) should be done within 10
days of the exposure to know whether the patient is
immune or not.
• Rubella specific IgG antibodies are present for life
after natural infection or vaccination.
• If the patient is not immune - therapeutic
termination should be seriously considered.
• PCR - Detection of viral RNA
• Prenatal diagnosis using PCR - chorionic villi, fetal
blood and amniotic fluid samples.
MEASLES
• Non-teratogenic.
• However, high fever may lead to
i. Miscarriage, FGR, microcephaly, stillbirth,
preterm baby
• Non-immunized women - IM immune serum globulin
(5 mL) within 6 days of exposure.
• Pneumonia, encephalitis develop high mortality
• Detection of IgM, detection of viral RNA (RT-PCR)
• Management : supportive care
INFLUENZA
• The course of pregnancy remains unaffected
• if the infection is virulent - abortion or premature
labor.
• There is no evidence of its teratogenic effect even
if it is contracted in the first trimester.
• Outbreak of Asian influenza - increased incidence
of congenital malformation (anencephaly) - first
trimester.
• Influenza (inactivated) vaccine is safe In
pregnancy and also with breastfeeding.
• Diagnostic test – rapid influenza diagnosic test
• Treatment
– Acetaminophen
– Oseltamivir 75mg PO BID for 5 days
– Inactivated vaccine
CHICKENPOX (Varicella)
Asymptomatic period
Multiple opportunistic
infection Candida, Tuberculosis, pneumocystis and others.
MALARIA TOXOPLASMOSIS
INTESTINAL
LISTERIOSIS
WORMS
MALARIA
MALARIA
• Malaria is predominantly a tropical disease.
• In India and other south east Asian countries
there is resurgence of malaria.
• The diagnosis is confirmed by the detection of
malarial parasites in peripheral thick blood
smear.
Pathogenesis
• Hemolytic anemia
• Maternal HIV or tuberculosis causes intense
parasitization of the placenta
• The fetal effects are due to high fever or due to
placental parasitization.
• The intervillous spaces become blocked with
macrophages and parasites and there is
diminished placental blood flow. This is mostly
seen with P. falciparum infection and in the
second half of pregnancy.
• Congenital malaria is rare (< 5%) unless the
placenta is damaged.
Severity of infection depends on
immunity state
Complications are high
Management
• Prevention from mosquito bites is done using
pyrethroid-impregnated mosquito nets and
electrically heated mats.
• Chemoprophylaxis:
– Chloroquine 300 mg/weekly, 2 weeks before
travel and covering the period of exposure and 4
weeks after leaving the endemic zone.
– Mefloquine 250 mg/week : alternative drug for
chloroquine-resistant.
Investigation
• Rapid antigen detection test
– Parasite F-test
– Dual antigen test
• Molecular diagnosis
– DNA probe
– PCR –for species specification
Treatment
• Chloroquin—10 mg base/kg p.o. followed by 10 mg/kg at
24 hours and 5 mg/kg at 48 hours.
• For radical cure - primaquin should be postponed until
pregnancy is over.
• Parasites resistant to chloroquin - quinine (10 mg salt/kg
p.o. every 8 hours for 7 days) under supervision.
• Patients with severe anemia may need blood transfusion.
• The antimalarial drugs - no effect on uterine contraction
unless the uterus is irritable.
• Folic acid 10 mg should be given daily to prevent
megaloblastic anemia.
• Complicated anemia : artesunate
TOXOPLASMOSIS
• Caused by Toxoplasma gondii.
• Infection is transmitted through encysted
organism by eating infected raw or uncooked
meat or through contact with infected cat
feces.
• It can also be acquired across the placenta.
• During parasitemia, transplacental infection to
the fetus occurs.
• The affected baby may develop :
i. hydrocephalus,
ii. chorioretinitis
iii. cerebral calcification
iv. microcephaly
v. mental retardation
• Acute infection is diagnosed by:
i. detecting IgM specific antibody,
ii. High level of IgG antibody titre
iii. detection of seroconversion for IgG from negative to
positive.
• Chronic maternal toxoplasmosis is not
considered to be a significant cause of
recurrent abortion as parasitemia will not be
repeated in subsequent pregnancies
• If current infection is confirmed the following
tests are carried out:
• (1) Amniocentesis and cordocentesis for
detection of IgM antibody in the amniotic fluid
and fetal blood. PCR for T. gondii gene is also
done
• (2) Ultrasonography at 20–22 weeks for
ventricular dilatation. If the fetus is infected and
hydrocephalus is present, counseling for
termination is to be done.
Treatment
• Toxoplasmosis is a self limited illness in an immunocompetent
adult and does not require any treatment.
• Pyrimethamine - 25 mg orally daily and oral sulfadiazine 1 gm four
times a day is effective.
*Pyrimethamine is not given in the first trimester
• Leucovorin is added to minimize toxicity. Four to six weeks course is
usually given.
• Spiramycin (3 gm orally daily) has also been used as an alternative.
• Acute toxoplasmosis during pregnancy is treated with spiramycin.
• Extended courses may be needed in an immunocompromised
patient to cure infection.
• Treatment to the mother reduces the risk of congenital infection
and the late sequelae.
Prevention
NO
• Uncooked meat
• unpasteurized milk
• contact with stray cat or cat litter are to be
avoided.
LISTERIOSIS
LISTERIOSIS
• Listeria monocytogenes (LM) is an intracellular
gram-positive bacillus.
• Found in soil and vegetation. It can grow and
multiply in temperature as low of 0.5°C.
• Infection is caused by eating infected food or
through contact with infected miscarried
products of animals.
• Maternal symptoms are ‘flu-like’ or “food
poisoning”.
• No reliable serological test for it except the blood
culture during septicemia.
• Neonatal death due to septicemia is also high
(10%).
• Overall perinatal mortality is 50%.