INFECTION IN PREGNANCY:

TB, MALARIA AND CHICKENPOX

Nur Amalina bt. Aminuddin Baki

082012100067

Tuberculosis in pregnancy 1-2 % Risk factors

Positive family/past history Low socioeconomic status High TB prevalence area HIV infection IV drug abuse Diabetes

Effect of Pregnancy on TB Pregnancy aggravated TB

Lesions remain same Same mortality rate for pregnant and

non-pregnant TB women (treated) No increase in relapse No increase in risk of active TB in HIV

(+)ve mothers

Effect of TB on pregnancy Affect fertility if associated with

genital TB Slight increase in abortion, IUGR and

preterm labour Rare transplacental infection Neonatal infection mainly by

postpartum maternal contact or aspiration of amniotic fluid

Diagnosis of Mother

May be delayed (nonspecific early symptoms)

Cough, haemoptysis, fever, weight loss

Any pregnant/puerperal women with unexplained cough and sputum

Tuberculin skin test Chest X-ray

(>12w) Early morning

sputum for AFB Gastric washings Diagnostic

bronchoscopy Direct

amplification tests

Diagnosis of Congenital TB Lesion in first week of life Primary hepatic complex / caseating

hepatic granuloma by percutaneous liver biopsy at birth

Infection in maternal genital tract or placenta

No evidence of post natal transmission

Management : Medical

Prophylaxis Asymptomatic women (>35y/o) with

(+)ve PPD Isoniazid 300mg/day after 1st trimester

for 6-9 months Pyridoxine 50 mg/day

Treatment

Management: Surgical

Thoracic surgery Hold back if possible Restricted to 12 to 20 weeks

Management: Obstetric Therapeutic termination:

maybe in MDR-TB Avoid breastfeeding if mother and child is on

drugs Prophylaxis for baby if mother have active TB

isoniazid 10-20 mg/kg/day for 3 months till mother become sputum (-) ve.

BCG given as soon as possible. Avoid pregnancy till two years of quiescence Avoid OCP with rifampicin

Introduction

Tropical disease causing complication in pregnancy.

Female Anopheles mosquito Haemolysis of RBC and

microcirculation blockage due to sequestrated RBC.

Pregnancy increases risk, severity and complication of infection

Effect of Malaria on

MOTHER

Megaloblastic anemia Hypoglycemia Metabolic acidosis Jaundice Renal failure Pulmonary edema Cerebral malaria

FETUS

Due to high fever and placental parasitization.

Mostly in p. falciparum infection and 2nd half of pregnancy.

Abortion, preterm labor, IUGR and IUFD

Congenital malaria is rare unless placenta is damaged

Management

Prevention ▪ Pyrethroid-impregnated mosquito

nets▪ Electrically heated mats▪ Chloroquine 300mg weekly▪ Mefloquine 250mg/week

( chloroquine-resistant)▪ from 2 weeks before travel to 4 weeks

after travel.

Treatment

Chloroquine ▪ 10 mg base/kg PO▪ 10mg/kg at 24 hours▪ 5mg/kg at 48 hours

Primaquin (radical cure) postponed till end of pregnancy

Quinine ( chloroquine-resistant) 10 mg salt/ kg every 8 hours for 7 days

Folic acid 10mg daily

Complicated malaria

IV artesunate 2.4mg/kg at 0 ,12 , 24 hours , then daily

Oral artesunate 2mg/kg starts when patient is stable

IV quinine can also be given Limited use▪ Only in 2nd or 3rd trimester when other drugs

are resistant

Varicella Zoster Virus

Cross placenta congenital/neonatal chickenpox

High maternal mortality due to varicella pneumonia

Congenital Varicella Syndrome Limb hypoplasia Limb deformity ( absent if infection

after 20 weeks) Choroidoretinal scarring Cataracts Microcephaly Cutaneous scarring

Diagnosis

Varicella PCR ELISA

Treatment

Live attenuated varicella vaccine not recommended

Varicella Zoster Immunoglobulin to exposed non-immune person Newborn exposed within 5 days of

delivery Oral acyclovir ( within 24 hours )

decrease illness duration

Listeria Monocytogenes Intracellular Gm (+)ve bacillus In soil and vegetation

Eating infected food/ animal products

Reliable serological test: blood culture during septicemia

Listeriosis

Flu-like/ food poisoning maternal symptoms

Obstretric complication: Late miscarriage ,preterm labor, stillbirth Neonatal death (10%)

Treatment: Ampicillin and gentamicin Trimethoprim and sulfamethoxazole

PreventionUnpasteurized milk, soft cheese, refrigerated smoked seafood

Intestinal Worms

Hookworms : 700-900 million worldwide

Roundworms : 25% of world’s population

Most common infestation in tropics Diagnosis: stool examination Treatment :

deworming ( excluding 1st trimester) Iron therapy for anemia

Referance