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ANTHRAX IN PREGNANCY CASE REPORTS

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 ?.

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ANTHRAX IN PREGNANCY CASE REPORTS

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  1. ANTHRAX IN PREGNANCYCASE REPORTS AYTEN KADANALI İSTANBUL-TURKEY

  2. UNKNOWN MATTERS IN ANTHRAX DURING PREGNANCY Is there a difference in thecourse of anthraxduringpregnancy? Aretherisks of adversepregnacyoutcomesincrease in anthraxduringpregnancy?

  3. THE GEOGRAPHIC LOCALIZATION OF OUR CASES

  4. 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

  5. CASE-1 • 33 yearsoldpregnantwomen • 32 weeks of pregnancy History: She had flayed a deadcow 7 daysearlier

  6. Clinicalfindings • Submandibulareschar • Surrondingvesicles • Extensiveedema (face, neck, upperthorax) • Difficulties in respiration • Fever(38 ˚C)

  7. ObstetricalExamination • Ultrasoundexamination • Fetalbiometryappropiatefor 32 weeks of pregnancy, amnioticfluidvolumeandplacenta normal, • -Cervix : nosigns of dilatation • No uterinecontraction • NO SIGNS OF PRETERM LABOR

  8. LABORATORY EVALUATİON • - WBC count 28.300 cells/mm3 • Large gram- positive on directmicroscopicexamination • Blood culturewastaken • Routinebiochemicaltestswere in normal limits • B.anthraciswasisolatedfromthelesion

  9. CLINICAL PROGRESSION • Penicillin G 8 x 3 millionunits/day IV wasadministeredimmediately (at the 4th day of disease) for 10 days • Prednisolone 100 mg/ day ( 75 mg morning-25 mg evening) wasalsoadministeredwithantibiotic. Dosewasgradualydecreasedandstopped at day 6 of therapy • Signsandsymptoms of anthraxweregraduallydisapperadexceptlocalscarring.

  10. CLINICAL PROGRESSION • Rapidpretermlaborwasbegunandresulted in pretermdelivery at the 13th day of hospitalization. • APGAR score of babywas 8. • No signsandevidence of congenitalinfection. • BOTH MOTHER AND BABY DISCHARGED IN GOOD CONDITION

  11. CASE-2 • 29 years of pregnantwomen • 33 weeks of gestationalage • History: • Handledillcow 12 daysago • İncubationperiodwas 7 days

  12. Clinicalfindings • Swelling of rightarm • Weepinglesion at theright • elbow • 2 cm opensorewithsurroundingerythema • Induration, oozingserousfluid • Fever (38.5 ˚C)

  13. ObstetricalExamination • Ultrasoundexamination • Fetalbiometryappropiatefor 33 weeks of pregnancy, amnioticfluidvolumeandplacenta normal, • -Cervix : nosigns of dilatation • No uterinecontraction • NO SIGNS OF PRETERM LABOR

  14. LABORATORY EVALUATION • - WBC count 19.600 cells/mm3 • Large gram-positive on directmicroscopicexamination • Blood culturewastaken • Routinebiochemicaltests • were in normal limits • B.anthraciswasisolated • fromthelesion

  15. CLINICAL PROGRESSION • ProcainePenicillin 2 x 800.000 units/day IM wasadministeredimmediately (at the 5th day of disease) for 7 days • Prednisolone 75 mg/ day ( 50 mg morning-25 mg evening) wasalsoadministeredwithantibiotic. Dosewasgraduallydecreasedandstopped at the 6th day of therapy • Signsandsymptoms of anthraxweregraduallydisapperadexceptlocalscarring.

  16. CLINICAL PROGRESSION • On theday of dischargefromthehospital (8th day), pretermlaborwasbegun • Tocolytictherapywasunsuccessfulandpatientwasdelivered at 34 weeks • APGAR score of babywas 8. • No signsandevidence of congenitalinfection. • BOTH MOTHER AND BABY DISCHARGED IN GOOD CONDITION

  17. PEARLS FROM THE CASES - 1 Anthraxduringpregnancy can be successfullymanaged as in nonpregnantwomen Clinicalprogression of theanthrax is similartononpregnantwomen Promptclinicalsuspicionandrapidadministration of effectiveantimicrobialsareessential.

  18. PEARLS FROM THE CASES - 2 Penicillin is stillthedrug of choice in thetheraphy of anthraxduringpregnancy Increasedplasmavolume of pregnancyshould be takenintoconsideration in thedosing of antibiotics High doseprednisolonetherapymay be beneficial Pretermdeliverycould be expected

  19. PEARLS FROM THE CASES - 3 Inthesecases, theevaluation of pretermdeliverywould be worthwhile; - Itwas at theend of theanthraxtherapy -Suddenonset of pretermdelivery -Unresponsivenesstotocolysis -Occurencewithout PROM

  20. PEARLS FROM THE CASES - 4 • Wemayalso be interest on theeffects of highdoseprednisolonetherapy: • - Clinicaloutcome • reducingmortality ??? • - Pregnancyoutcome • delayingpretemdelivery ??? • - Benefitstonewborn • Reducing RDS andventricularhemorrhage

  21. THANK YOU FOR YOUR ATTENTION

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