1

CASE REVIEW INFEKSI TORCHKASUS

PAGE 1-1

Mrs.Rifi, aged 26 years old, is expecting her second baby. Her first son was born healthy 3 years ago, but she is worried now because she just watched a TV program pf infectious disease in pregnancy. She is her 16th week of pregnancy and all this time she was in perfect health. She has done some routine laboratory exams which were normal, but has never run any test for TORCH. She fears that she might catch the disease in her pregnancy.

PAGE 1-2

The physical examination shows :

Vital sign and general physical findings are within normal limit.

Obstetric examination :

Fundal height : midway from symphysis to umbilicus

Ballottement : positive

Fetal heart sound normal

Ultrasound examination shows : A singleton baby with biparietal diameter and head circumference equal

to 16 weeks No signs of enlargement of the lateral-ventricles Spines were normal Other findings within normal limit

Additional lab test :

Toxoplasma IgG (+)

Toxoplasma IgM positive (titration 1 / 512)

IgG Avidity (+)

2

PAGE 2-1

Mrs.Rifi was on Spiramycin therapy under close supervision by her physician. She had repeated ultrasound scanning and the baby was found normal. Reaching 38 weeks pregnancy she delivered her baby spontaneously, giving birth to a male of 2500 grams (birth weight) and 46 cm (height). She is recovering well.

PAGE 2-2

Physical examination of the baby reveals :

General condition : not doing well Generised ptechiae Head circumference : 34 cm Large fontanel : normal Temperature : 39.2 o C Respiration : 70 times per minutes, mild retraction in the intercostals space Eye : icteric sclera Mild nasal flare Hearth rate : 170 bpm Lungs : normal Abdomen : distended Liver : 4 cm below costal ridge Spleen : schuffner 1

Laboratory :

Hb :11 gr/dL Leukocyte : 24.000 / mm3 Different ciunt : 0/2/8/30/58/2 Platelet count : 100.000 / mm3 Packed cell volume : 33 % Blood smear : red blood cell hypocrom, microcyter White blood cells : no cellular changes SGOT (AST) : 65 u/L SGPT (ALT) : 70 u/L Urine : within normal limit

3

Toxoplasm IgM : (-) Toxplasm IgG : (-) PCR for Toxoplasma : (+)

PAGE 2-3

After the treatment with Pyrimethamine plus sulfonamide in alternate with Spiondition. After ramysin every 3 weeks, and in addition with Folic acid administration, the baby was in a stable condition. After 1 month of treatment, the patient showed absence of fever, respiratory distress, nor seizure. The baby was also consulted to ophthalmology department, there was no ophthalmologic abnormalities concerning the presence of retinal scars and macular lesions. Neurological examination performed at age 4 months was normal.

PAGE 3-1

EPILOGUE

The boy survived and now he is a 9 year healthy boy. The parents learnt noe that when they expect their third pregnancy, genetic counseling ang pre conceptional counseling by a team work is compulsory, which consist of gynecologist, cellular and molecular biologist as well as psychologist.

Mrs.Rifi , 26 th , G0P1A0

4

Khawatir anaknya terinfeksi TORCH

Bayi Mrs.Rifi ( O )

ANAMNESIS :

Pemeriksaan lab rutin normal.

Belum pernah menjalani tes untuk TORCH

PX.FISIK IBU :

VT : NORMAL

KU : NORMAL

PX.OBSTETRIK :

Tinggi fundus : 2 jari di atas simfisis.

Ballottement : (+)DJJ : NORMAL

PX USG :

Diameter biparietal sesuai umur kehamilan.

Tidak ada perbesaran lateral ventrikel.

Tulang belakang : NORMAL

Px lain : normal

PX LAB IBU :

Toxo IgG : (+)

Toxo IgM : (+) titration 1 / 152)

IgG avidity : (+)

TORCH :

Definisi

Etiologi

Epidemiologi

Klasifikasi

Pathogenesis , patofisologi

Faktor resiko

Menifestasi klinik

Diagnose

Komplikasi

terapi

FISIK IBU NORMAL

Hamil 16 minggu

Amnion NORMAL

JANIN NORMAL

IBU TOXOPLASMA AKUT

TERAPI SPIRAMICIN

5

Bayi laki-laki Mrs Rifi bertahan dan kini menjadi seorang anak laki-laki berusia 9 tahun yang sehat.

ANALISA KASUS

PX FISIS :

Ptec hiae

Temperature

Mata

Respirasi

Abdomen : hepar dan spleen

PX LAB :

Hb

Leukosit

Different count

Platelet count

Packed cell volume

Blood smear

White blood cells

SGOT

SGPT

Urine

Toxo IgM

Toxo IgG

PCR for toxoplasma

TERAPI :

Pyrimethamin + sulfonamide bergantian dengan spiramycin + asam folat per 3 minggu bergantian.

Neurological

Ophthalmology

6

Pada kasus ini, dalam pemeriksaan laboratorium bayi Ny,Rifi hasilnya adalah :

bila IgG (-) dan IgM (-)

Belum pernah terinfeksi dan beresiko untuk terinfeksi.

Bila sedang hamil, perlu dipantau setiap 3 bulan pada sisa kehamilan (dokter mengetahui kondisi dan kebutuhan pemeriksaan anda).

Lakukan tindakan pencegahan agar tidak terjadi infeksi.

PCR (polymerase chain reaction) merupakan suatu teknik atau metode perbanyakan DNA secara enzimatik . (termasuk DNA toxoplasma)

Jadi apabila hasilnya (+) maka terdapat DNA virus toxoplasma.

Maka, dapat kita simpulkan bahwa bayi Ny.Rifi sudah terinfeksi toxoplasma dari ibunya.

KESIMPULAN

Kehamilan tidak mengubah daya tahan tubuh seorang wanita terhadap infeksi. Namun, keparahan setiap infeksi berkorelasi positif dengan efeknya pada janin.

• Infeksi mempunyai efek tidak langsung dan langsung pada janin. Efek tidak langsung timbul karena mengurangi oksigensi darah plasenta dan mengganggu pertukaran nutrisi melalui plasenta. Efek langsung tergantung pada kemampuan organisme penyebab menembus plasenta dan menginfeksi janin.

• Secara anatomik dan fisiologik ibu hamil juga mengalami perubahan, sehingga mempermudah terjadinya infeksi.

• Infeksi bisa disebabkan oleh bakteri, virus, dan parasit, sedangkan penularan dapat terjadi intrauterine pada waktu persalinan / pascalahir. Transmisi bisa secara transplasenta / melalui aliran darah / cairan amnion.