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.

 

Caustive Organism

        Toxoplasmosis is caused by Toxoplasma Gondii.

 

Mode of Transmission

          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 1^st 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.

 

          Then the methods of preventing toxoplasmosis also should be educated.

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

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, 2^nd Page No.33-36.