HIV in pregnancy: a case of Pneumocystis (carinii) jiroveci pneumonia

The role of opportunistic pathogens as etiological agents of intrauterine infections

The study showed a high prevalence of markers of herpesvirus infections among mothers — from 71% to 98% of HSV, EBV and CMV infections and from 29% to 58% of HHV-6 infection. HSV remains the most common etiological agent of intrauterine infections among herpesviruses — markers of active infection caused by this virus were found in 28.3% samples. The difficulty of determining the source of infection in the absence of data in the early stages of pregnancy is presented on 4 out of 10 cases of active HHV-6 infection. Markers of active pneumocystic infection were detected only in mothers: in the group with children under the age of 21 days — in 21—27% of cases, with children aged 22 to 28 days — in 15—21%. In addition to non-specific multiple organ failure during intrauterine infections (26.3%), only one organ system was observed: hypoxic-hemorrhagic lesions of the central nervous system were diagnosed more often — 17%, as well as meningitis/encephalitis, or hepatitis, or pneumonia, or disorders of hematopoiesis, or rash. In 17.5% of children from the comparison group, i.e. without any clinical manifestations of intrauterine infections, markers of active herpes virus infections were detected.

[Lung ultrasonography for the diagnosis of pneumonia in pregnant women with blood system tumors]

AIM

To estimate the informative value of ultrasonography (USG) in the diagnosis of lung injuries in pregnant women with blood system tumors.

SUBJECTS AND METHODS

Lung ultrasound was performed in 5 pregnant patients with blood cancers. The women's age was 29-38 years; gestational age was 14-33 weeks. Four women had different types of acute leukemia; one had primary mediastinal large B-cell lymphoma. All the women received chemotherapy for blood cancer. When there were signs of lung injury, USG was conducted, the results of which necessitated therapy or bronchoalveolar lavage (BAL).

RESULTS

Three patients developed acute respiratory failure; 2 of them required noninvasive ventilation. Based on the detection of consolidation with a dynamic air bronchogram and pleural effusion, the authors diagnosed bilateral pneumonia and alveolar-interstitial syndrome in 1 patient, right-sided pneumonia in 1, left-sided one in 1, and transfusion-related pulmonary edema in 1. Lung ultrasound did not verify the diagnosis of pneumonia in 1 patient. According to USG data, BAL procedures were performed in 2 patients; one of them was diagnosed as having Pneumocystis pneumonia; the other was found to have no pathogens in lavage fluid. Treatment resulted in clinical improvements and normalization of the lung ultrasound pattern in all the pregnant women. Later on, 4 women delivered via cesarean section done at 32-34 weeks' gestation and gave birth to healthy babies. One patient died from infectious complications after chemotherapy.

CONCLUSION

Lung sound may be used to diagnose lung injury in pregnant women with blood cancers.