| We report a case of the prenatal diagnosis of fetal cataract due to congenital toxoplasmosis. To the best of our knowledge, this is the first report of such a case. We discuss the long-term ocular sequelae of the condition and how they should affect prenatal counselling. ( info) |
2/70. Low levels of natural killer cells in pregnant women transmitting toxoplasma gondii. The role of cell-mediated immunity in the maternal-fetal transmission of toxoplasma gondii was investigated in 17 pregnant women with primary T. gondii infection, in 7 of whom fetal infection occurred. 18 healthy pregnant women were followed-up as controls. Fetal outcome was uneventful in six women who were treated early in pregnancy with spiramycin, while stillbirth due to T. gondii encephalitis occurred in the offspring of one patient who started with therapy at 34 weeks' gestation. All patients who transmitted T. gondii showed significant changes in the mean levels of immune cells. The most prominent finding was a significantly lower level of natural killer (NK) cells in the mothers transmitting T. gondii to the fetus compared with non-transmitters and controls both in the number (99.7 (71.8-107.5)/microl versus 320.9 (307.9-356.4)/microl and 172.1 (122.4-213.3)/microl: median (25 degrees-75 degrees). p<0.001) and the percentage of NK cells (4.0 /-1.5 per cent versus 13.2 /-2.3 per cent and 10.2 /-3.4 per cent; mean /-SD, p<0.001). Although limited by the small number of patients, our data suggest that the assessment of NK cells may be considered as a prognostic marker of primary T. gondii infection in pregnancy. ( info) |
3/70. Management of severe and complicated malaria in the intensive care unit. malaria remains today one of the major health problems in the tropics with increased morbidity and mortality. The most serious complications are caused by plasmodium falciparum, which, in contrast to the benign malarias, may progress to a life-threatening multi-system disease. Our case concerns a young woman in the 14th week of pregnancy, admitted to the ICU in a coma, with pulmonary oedema, haemolytic anaemia, renal failure and thrombocytopenia as complications of P. falciparum malaria. The case is discussed and possible explanations for the clinical picture and complications of P. falciparum malaria are given in the light of experiences from the literature. ( info) |
4/70. Pseudocystic form of neurocryptococcosis in pregnancy. Case report. We report a case of neurocryptococcosis which is unique in the literature because the patient had a pseudocystic form of the disease during pregnancy and without any evidence of AIDS. The clinical picture was that of intracranial hypertension and the epidemiological background was highly suggestive of cysticercosis. CT showed multiple round hypodense lesions in the basal ganglia and cerebellum, without contrast enhancement. Since a scolex was not visible, the diagnosis of neurocysticercosis was considered probable. CSF examination was not performed in view of its high risk. The patient had progressive downhill course. autopsy disclosed multiple gelatinous pseudocysts in the cerebral and cerebellar gray matter, containing abundant cryptococcus neoformans. Meningeal involvement was minimal. The child was delivered by caesarean section and was free of infection, but died later of hyaline membrane disease. The neuroimaging appearances of this rare instance of the pseudocystic form of neurocryptococcosis mimicked closely neurocysticercosis and only postmortem examination allowed correct diagnosis. The pseudocystic form has so far only been reported in AIDS. ( info) |
5/70. Image analysis of nucleomegalic cells in Chagas' disease placentitis. Villous stroma nucleomegalic cells harbouring intracytoplasmic parasites are an unusual finding which appears to be restricted to Chagas' disease placentitis. Ploidy analysis of these cells in two cases (twelve nuclei in Case 1 and 26 in Case 2) showed these nuclei to contain quantitatively abnormal dna. Only a few were diploid, the rest proving to be tetraploid, hypertetraploid and even aneuploid. Little is known about the pathogenesis of these macronuclei. However, since these cells contain large numbers of parasites it is possible that a parasite-induced derangement of the cell cycle at g2 phase may be operative. ( info) |
6/70. Congenital malaria: a case report. Congenital malaria is an uncommon disease even in endemic areas. A 19-day-old female infant with congenital malaria is presented. The mother of the patient was diagnosed to have malaria at the seventh month of gestation and was treated with chloroquine orally for three days. No malarial prophylaxis was given. The infant developed fever, hyperbilirubinemia, anemia and hepatosplenomegaly postnatally. Thin blood smears revealed many plasmodium vivax parasites. She was treated with oral chloroquine for three days. We emphasize the importance of adequate antenatal medical therapy and prophylaxis during pregnancy. ( info) |
| BACKGROUND: neurocysticercosis is an infection of the central nervous system with the pork tapeworm's cysticercus. CASE: A 21-year-old Hispanic primigravida presented at 33 weeks' gestation with acute onset of mental status changes preceded by headaches and emesis. She was transferred comatose to our institution with a diagnosis of postictal state secondary to eclampsia. Upon arrival, the patient developed anisocoria, papilledema, posturing, and hypertension. neuroimaging showed an intraventricular cyst. The patient was treated with ventriculostomy, induction of labor, postdelivery shunting, albendazole, and prednisone. CONCLUSION: neurocysticercosis should be considered in the differential diagnosis of pregnant patients with coma and/or seizures, especially if the patient has emigrated from or traveled to an endemic area. albendazole, with shunt procedure, is the treatment of choice for intraventricular neurocysticercosis. ( info) |
8/70. myiasis in a pregnant woman and an effective, sterile method of surgical extraction. BACKGROUND: Cutaneous myiasis caused by Dermatobia hominis involves the infestation of tissue with dipterous fly larvae and is common in many tropical and subtropical areas. We describe a patient in her sixth month of pregnancy who returned from belize with myiasis detected in the right popliteal fossa. Multiple surgical techniques have been described in the past outlining various ways to extract the botfly larva. No single standardized technique for surgical extraction of larvae has been adopted. OBJECTIVE: To describe a highly effective, sterile method of extraction used in a pregnant patient with botfly infestation. methods: A combination of injection with plain 1% lidocaine, sterile occlusion with polymyxin b sulfate ointment and a cruciform incision was used to extract the larva. RESULTS: The botfly larva was easily and completely extracted without remnants of the larval body being left in the skin. CONCLUSION: The sterile technique we describe allows for quick and easy extraction of the larva without risk of secondary infection or need for antibiotics. This method is especially appropriate for pregnant patients or those with medical conditions precluding a completely competent immune response to potential secondary infection. ( info) |
9/70. The potential utility of the Semi-Nested Multiplex PCR technique for the diagnosis and investigation of congenital malaria. We report three cases of congenital malaria involving two malarial immune mothers living in spain. Diagnostic PCR and Genotyping PCR for merozoite surface proteins 1 and 2 were essential to show that mothers and new-borns had different Plasmodium population parasites at the moment of the delivery, and that the infection was acquired earlier in gestation by transplacental transmission. In the first case the Plasmodium species founded in both, mother and child were different. malaria in the twins showed a mixed infection (P. falciparum plus P. malariae) while the mother presented a P. falciparum infection. These facts were confirmed studying the polymorphisms for MSP1 and MSP2. Blood samples of the newborns were analyzed an half hour after delivery excluding the possibility of re-infection by mosquito bite and indicating a vertical transmission during pregnancy. ( info) |
| The persistence of plasmodium falciparum in the placenta after apparently adequate therapy with quinine has been described. We describe this phenomenon in the placenta of a 19-year-old woman with falciparum malaria, who was treated with a combination of quinidine and clindamycin. Although this therapy was effective and diminished her peripheral blood parasitemia from 3% at presentation to almost undetectable at the time of delivery, vast numbers of P. falciparum-infected erythrocytes were present in the maternal sinusoids of the placenta. This sequestration of infected erythrocytes produced a local parasitemia in the placenta of 70% to 80%. Additionally, rare Plasmodium-infected erythrocytes were also seen in the fetal blood of the placenta. We review malaria in pregnancy, parasitic involvement of the placenta and emphasize that Plasmodium-infected erythrocytes may persist in the placenta even after clearance of parasites from the peripheral blood. ( info) |