Protozoal infections
INTRODUCTION
A
woman of childbearing age can acquire numerous infection. An infection in pregnancy not only cause
discomfort but results in potentially serious maternal disease or adverse pregnancy outcome such as abortion and
premature labour. The most common
infections that affects pregnancy includes, viral, infections and protozoal
infection.
TOXOPLASMOSIS
Definition;
Toxoplasmosis
is a multisystem disease caused by protozoa.
It results in spontaneous abortion, preterm labour still birth and congenital
malformation.
Toxoplasmosis is caused by Toxoplasma
Gondii.
Infection
is transmitted through
Ø Encysted
organism by eating infected raw or uncooked meat.
Ø Hand
to mouth contact after disposal of cat litter.
Clinical
Manifestation
1.
Subjective
§ Malaise
§ Fatigue
2.
Objective
§ Fever
§ Lymphadenopathy
Diagnostic
Evaluation
Ø Serological
testing
Ø Ultrasound
Ø Antibody
titre blood tests
Ø Polymerase
chain reaction.
If infection is confirmed then,
Ø Aminocentesis
Ø Ultrasonography
Management
Medical
Management
If
the fetus is infected but is otherwise normal or the parents do not want
termination, the following drug regimen is to be followed. If the infection occurs prior to 28 week.
Pyrimethamine 25mg
Oral sulphacliazine 1gm 4 times a day
Folic acid 5mg 3 times for
Rovamycin 3 weeks
Ø Leucovorin
is added to minimize toxicity.
Ø Spiramycin
3gm orally daily, has also been used as an alternative.
Ø Pyrimethamine
is not given in 1st trimester.
NURSING MANAGEMENT
Ø Pregnant
women should be advised about proper antenatal visits (i.e.,)3 visits during
the period of pregnancy.
Ø The
nurse should properly advice the mother about the dietry requirement during
pregnancy i.e., the diet which contains green leafy vegetables and fruits.
Ø If
any mother comes with the signs and symptoms of infection then her serological
testing should be done.
Ø If
any mothers appears pale during the antenatal visits her Hb% should be checked
immediately. If she tends to anemic thin
iron rich food should be advised to take.
Like green leafy vegetables and fresh fruits.
Ø During
antenatal visits the nurse should also see to its whether any women comes with
signs and symptoms of toxoplasmosis. If
the nurse finds an antenatal mother with malaise then she can advice proper rest
and proper intake of diet. If myalgia
then she can manage it with hot applications, exercise antispasmodic and sodium
and calcium supplements.
1.
Women must be educated about
the adverse effects of properly cooked meat especially host and beef etc.
2.
The mother should be advised to boil the milk before using it.
3.
The mother should be advised by
the nurse that the cat litter box should be cleaned by some one else other than
the mother so that she can avoid contact with infected cat feces.
4.
The pets should not be allowed
inside the house.
5.
The pregnant women should stay
away from the pets.
6.
The nurse should also stress
the importance of wearing gloves when gardening and if avoiding gardening and of avoiding garden areas were
cats are frequently roaming.
Complications
Ø Parasitaemia.
Ø Hydrocephalus
Ø Choroidorepinitis
Ø Cerebral
calcification
Ø Microcephaly
Ø Mental
retardation.
MALARIA
Definition:
Malaria
is a communicable protozoal disease. It
is transmitted to man by species of infective female anopheles mosquitoes
called vectors or carriers.
Caustive
factor
Malaria
is caused by Plasmodium falciparum.
Incubation
period
10-12
days
Mode
of transmission
Ø Vector
transmission
Ø Direct
transmission
Ø Congenital
malaria
Vector
transmission:
Through
the bite of female anopheles mosquito.
Direct
transmission:
By
hypodermic intramuscular and intravenous injection of blood or plasma
LIFE
CYCLE OF MALARIA PARASITE
Clinical Manifestation
1.
Subjective
a.
Malaise
b.
Head ache
c.
Muscle ache
d.
Chills
e.
Thirst
2.
Objective
a.
High fever
b.
Anemia
c.
Enlarged spleen
d.
Dehydration
e.
Renal failure
Diagnostic
evaluation
a.
Blood smear examination
b.
Fluorescent microscopy
c.
PCR based detection of
plasmodium DNA in blood.
MANAGEMENT
Medical
management
Chloroquine
Salts 4 tab 600mg followed by tablets after 1 hours. There after 1 tab twice daily for 2
days. Total 10 tablets are required.
Nursing
Management
Ø Detailed
history is taken from any pregnant women who has recently traveled to an area
of endemic disease particularly if she presents with pyrexia.
Ø The
nurse should also be vigilant for any signs of mosquito marks, if a women has
recently returned from a high risk country.
Ø If
there is any suspicious that malaria could be possible cause, doctor should be
notified as well as department of health as it is a communicable disease.
Ø Nurse
should advice the mother about the importance of antenatal visits and when she
has to come for visits.
Ø During
the antenatal visits if any pregnant women complaints of rigors and chills
then.
a.
Detailed history should be
collected whether she has recently traveled to on area of endemic disease.
b.
If there is any stagnant water
or garbage’s in front of house.
c.
Blood test should be done to
know whether malaria parasites are present.
d.
If peripherial smear for malarial parasite appear to be positive
then following measures should be advised to the pregnant women.
a.
Do not allow water to stagnate
in front of the house.
b.
DDT should be spared every now
and then.
c.
Garbage’s should be decided in
a pit away from the house.
d.
Mosquito repellent creams or
nets should be used during night while sleeping.
e.
Vital signs should be checked
by the nurse.
f.
Temperature should be checked
every 2 hours.
g.
Tipied sponging should be given
h.
Advice the pregnant women to
take adequate diet that is green leafy vegetables, fruits fish milk etc in
order to contact the anemia.
Complications
1.
Effects of malaria on the other
a.
Anemia
b.
Hypoglycemia
c.
Metabolic acidosis
d.
Jaundice
e.
Renal failure
f.
Pulmonary oedema
g.
Convulsion and coma – cerebral
malaria.
2.
Effects on the fetus
a.
Abortion
b.
Preterm labour
c.
Pre-maturity
d.
IUGr
e.
IUFD
CONCLUSION
Protozoal
infections are very common now a days.
Infection in pregnancy will affect the fetus as well as the mother.
BIBLIOGRAPHY
1.
Text Book of Obstetrics,
D.C.Dutta, Sixth Edition 2004, page 295-296.
2.
A comprehensive text book of
Midwifery Annamma Jacob’s Edition, 2nd Page No.33-36.
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