anthrax in pregnancy case reports
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ANTHRAX IN PREGNANCY CASE REPORTS. AYTEN KADANALI İSTANBUL-TURKEY. UNKNOWN MATTERS IN ANTHRAX DURING PREGNANCY. Is there a difference in the course of anthrax during pregnancy ?. Are the risks of adverse pregnacy outcomes increase in anthrax during pregnancy ?. - PowerPoint PPT PresentationTRANSCRIPT
ANTHRAX IN PREGNANCYCASE REPORTS
AYTEN KADANALIİSTANBUL-TURKEY
UNKNOWN MATTERS IN ANTHRAX DURING PREGNANCY
Is there a difference in the course of anthrax during pregnancy?
Are the risks of adverse pregnacy outcomes increase in anthrax during
pregnancy?
THE GEOGRAPHIC LOCALIZATION OF OUR CASES
REPORTED HUMAN CASES OF ANTHRAX IN TURKEY
1960-1969 10724
1970-1979 5377
1980-1989 4423
1990-1999 4220
2000-2005 2210 2005-2010 ≈850
CASE-1
• 33 years old pregnant women
• 32 weeks of pregnancy
History:
She had flayed a dead cow 7 days earlier
- Submandibular eschar
- Surronding vesicles
- Extensive edema (face, neck, upper thorax)
- Difficulties in respiration
- Fever(38 ˚C)
Clinical findings
Obstetrical Examination
- Ultrasound examinationFetal biometry appropiate for 32 weeks of pregnancy, amniotic
fluid volume and placenta normal, -Cervix : no signs of dilatation
- No uterine contraction
NO SIGNS OF PRETERM LABOR
LABORATORY EVALUATİON
- WBC count 28.300 cells/mm3
- Large gram- positive on direct microscopic examination
- Blood culture was taken
- Routine biochemical tests were in normal limits
- B.anthracis was isolated from the lesion
CLINICAL PROGRESSION- Penicillin G 8 x 3 million units/day IV was
administered immediately (at the 4th day of disease) for 10 days
- Prednisolone 100 mg/ day ( 75 mg morning-25 mg evening) was also administered with antibiotic. Dose was gradualy decreased and stopped at day 6 of therapy
- Signs and symptoms of anthrax were gradually disapperad except local scarring.
CLINICAL PROGRESSION- Rapid preterm labor was begun and
resulted in preterm delivery at the 13th day of hospitalization.
- APGAR score of baby was 8.
- No signs and evidence of congenital infection.
BOTH MOTHER AND BABY DISCHARGED IN GOOD CONDITION
CASE-2
- 29 years of pregnant women
- 33 weeks of gestational age
- History:
Handled ill cow 12 days agoİncubation period was 7 days
- Swelling of right arm
- Weeping lesion at the right elbow
- 2 cm open sore with surrounding erythema
- Induration, oozing serous fluid
- Fever (38.5 ˚C)
Clinical findings
Obstetrical Examination
- Ultrasound examinationFetal biometry appropiate for 33 weeks of pregnancy, amniotic
fluid volume and placenta normal, -Cervix : no signs of dilatation
- No uterine contraction
NO SIGNS OF PRETERM LABOR
LABORATORY EVALUATION
- WBC count 19.600 cells/mm3
- Large gram-positive on direct microscopic examination
- Blood culture was taken
- Routine biochemical tests were in normal limits
- B.anthracis was isolated from the lesion
CLINICAL PROGRESSION- Procaine Penicillin 2 x 800.000 units/day
IM was administered immediately (at the 5th day of disease) for 7 days
- Prednisolone 75 mg/ day ( 50 mg morning-25 mg evening) was also administered with antibiotic. Dose was gradually decreased and stopped at the 6th day of therapy
- Signs and symptoms of anthrax were gradually disapperad except local scarring.
CLINICAL PROGRESSION- On the day of discharge from the hospital
(8th day), preterm labor was begun
- Tocolytic therapy was unsuccessful and patient was delivered at 34 weeks
- APGAR score of baby was 8.
- No signs and evidence of congenital infection.
BOTH MOTHER AND BABY DISCHARGED IN GOOD CONDITION
PEARLS FROM THE CASES - 1
Anthrax during pregnancy can be successfully managed as in nonpregnant women
Clinical progression of the anthrax is similar to nonpregnant women
Prompt clinical suspicion and rapid administration of effective antimicrobials are
essential.
PEARLS FROM THE CASES - 2
Penicillin is still the drug of choice in the theraphy of anthrax during pregnancy
High dose prednisolone therapy may be beneficial
Preterm delivery could be expected
Increased plasma volume of pregnancy should be taken into consideration in the
dosing of antibiotics
PEARLS FROM THE CASES - 3
In these cases, the evaluation of preterm delivery would be worthwhile;
- It was at the end of the anthrax therapy
-Sudden onset of preterm delivery
-Unresponsiveness to tocolysis
-Occurence without PROM
PEARLS FROM THE CASES - 4We may also be interest on the effects of
high dose prednisolone therapy:
- Clinical outcomereducing mortality ???
- Pregnancy outcomedelaying pretem delivery ???
- Benefits to newbornReducing RDS and ventricular
hemorrhage