Febrile Syndromes: With emphasis on Malaria in pregnancy. .pptx

Management of malaria in pregnancy to aid in better fetal outcomes

1. Infectious Febrile Syndromes in pregnancy Dengue, Malaria, Leptospirosis Dr. Kiaza Lewis Rotating GMO Obstetrics & Gynecology 2024

2. Introduction Febrile syndromes during pregnancy present a significant clinical challenge due to the physiological changes and immune adaptations that occur during this period. These changes can alter the presentation, progression, and outcomes of febrile illnesses, necessitating a nuanced approach to diagnosis and management. Illnesses which provoke febrile syndromes carry specific risks for pregnancy complications, including preterm labor, low birth weight, and congenital infections.

3. Febrile syndrome This is the body's natural reaction to invasion by an infectious disease or pathogen. Typically, acute febrile illness is characterized by a sudden rise in body temperature to levels above 38 degrees Celsius or 100.4 degrees Fahrenheit, and the associated symptoms can include headaches, dizziness, chills, sweats, weakness, or muscle pain.

4. Types of Fever

5. Types of Fever

6. Common Causes of Fever in Pregnancy Infections - Urinary Tract Infections (UTIs) - Respiratory Infections - Gastrointestinal Infections - Sexually Transmitted Infections (STIs) Non-Infectious Causes - Autoimmune Diseases - Drug Reactions

7. Specific Febrile Syndromes Influenza COVID-19 Pyelonephritis Malaria Dengue Fever Zika Virus Cytomegalovirus (CMV) Toxoplasmosis Leptospirosis Rubella Chikungunya Varicella (Chickenpox)

8. Epidemiology & Risk factors: Dengue Risk Factors Arterial Hypertension Obesity Diabetes Mellitus Previous dengue infection Pregnancy Age ( <14 years, >60 years) Climate (Temperature, humidity, rainfall) Living in or travelling to tropical and subtropical endemic areas Urbanization (Population density, human mobility, water storage practice) Biological environment (Situations that increase mosquito-breeding habitats around the home such as plant keeping, blocked gutters and street drains) Inadequate Vector surveillance and control activities (on a personal, community and national level)

9. Epidemiology & Risk factors: Malaria

10. Epidemiology & Risk factors: Leptospirosis

11. Differential diagnosis Dengue fever Malaria Leptospirosis Vector Aedes aegypti Aedes albopictus Anopheles species Animals: Rodents, dogs, livestock Causative agent Virus: DEN 1/2/3/4 Parasite: Plasmodium Spirochete Bacteria: Leptospira Distribution The Americas, Africa, Eastern Mediterranean, Western Pacific, South-East Asia The Americas, Africa, Asia, Eastern Europe, Caribbean, South Pacific Sub-Saharan Africa, Latin America, Caribbean, South & southeast Asia & Oceania Incubation Period 4 – 10 days 7- 30 days 2 – 30 days

12. Differential diagnosis of Common Febrile Syndromes Dengue fever Malaria Leptospirosis Clinical Manifestations Dengue Fever: Sudden high grade fever, headache, retro-orbital pain, myalgias , arthralgias . Weakness, rash, nausea, vomiting, petechiae , epistaxis, gingival bleeding Dengue hemorrhagic fever: Fever 2-7 days, hemorrhagic manifestation, thrombocytopenia, increased vascular permeability Dengue shock syndrome: DHF + hypotension, pulse pressure < 20 mmHg, or frank shock Fever, shaking chills, headache, myalgias , fatigue, nausea, vomiting, orthostatic hypotension Septicemic phase: Fever, headache, chills, myalgia, conjunctival suffusion, abdominal pain, nausea, vomiting, diarrhea, rash Immune phase (Weil syndrome): cardiac arrhythmias, hemodynamic collapse, hemorrhage, jaundice, liver failure, aseptic meningitis, pulmonary insufficiency, renal failure

13. Differential diagnosis Dengue fever Malaria Leptospirosis Diagnosis Within day 5 of symptom onset: virus isolation, RT-PCR, Antigen detection via ELISA After day 5 of symptom onset: IgM ELISA, IgM rapid test, IgG ELISA Blood smear (Giemsa stain) Rapid diagnostic tests Polymerase chain reaction PCR Microscopic agglutination test ELISA RDT Treatment Dengue fever: Supportive DHF & DSS: ICU hospitalization Artemisinin based combination, chloroquine, primaquine , atovaquone , proguanil , quinine, quinidine, doxycycline, clindamycin Mild cases: Doxycycline, ampicillin, amoxicillin , azithromycin Severe caes : IV penicillin, ceftriaxone, cefotaxime

14. Differential diagnosis Dengue fever Malaria Leptospirosis Complications Liver injury, cardiomyopathy, pneumonia, orchitis , oophoritis , seizures, encephalopathy, encephalitis Cerebral malaria, severe malarial anemia, nephrotic syndrome ARDS, circulatory collapse, DIC, pulmonary edema, coma, death DIC, hemolytic uremic syndrome, meningitis, liver failure, ARDS Prognosis DHF: Mortality rate <1% Uncomplicated Malaria: Mortality rate of 0.1% Severe malaria: Mortality rate of 10-20% Severe leptospirosis: 5 – 15%

15. Diagnosis and Monitoring Recognizing Symptoms - Laboratory Tests and Imaging - Maternal Monitoring - Fetal Monitoring

16. Management and Treatment General Principles - Antibiotic Therapy - Antiviral Therapy - Antipyretics and Pain Management - Hydration and Nutrition

17. Complications and Outcomes Maternal Complications Higher risk for Preeclampsia-eclampsia Risk of acute pulmonary edema Maternal liver enzyme derangement Post-partum hemorrhage Sepsis and/or shock Kidney injury Respiratory distress syndrome Liver failure Fetal Complications Development of Dengue hemorrhagic fever through vertical transmission Low birth weight Pre-term delivery Long-term Outcomes

18. Prevention and Vaccination Preventive Measures - Immunizations for Pregnant Women - Public Health Recommendations  

19. Case Studies and Clinical Guidelines - Case Study Examples - Best Practices - Current Clinical Guidelines

20. Psychosocial Aspects

21. Admit all pregnant women suspected with dengue Diagnosis & Assessment Challenges Baseline heart rate is higher Baseline blood pressure is lower (pulse pressure are wider ) HCT elevation may be masked haemodilution in 2nd & 3rd trimester Detection of third space loss is difficult with gravid uterus Risk of bleeding is highest during period of plasma leakage Avoid lscs or IOL during critical phase Avoid procedure or maneuvres that may provoke labour during critical phase Differential diagnosis: Toxemia, HELLP syndrome

22. Conclusion

23. References