Acquired Immune Deficiency Syndrome in Pregnancy
Introduction
Introduction to pregnancy-acquired immunodeficiency syndrome Acquired immunodeficiency syndrome (AIDS), or AIDS, is a serious infectious disease caused by human immunodeficiency virus (HIV). HIV infection causes T lymphocyte damage, leading to persistent immunodeficiency, multiple organ opportunistic infections and malignant tumors, which ultimately leads to death. HIV can cause intrauterine infection through the placental blood circulation, and birth canal secretions, blood, and postpartum breastfeeding during childbirth can also infect newborns. Because the immune function of pregnant women during pregnancy is reduced, after the HIV infection during pregnancy, the disease develops more rapidly and the symptoms are heavier. Patients may have significant fever, fatigue, night sweats, uncontrollable weight loss (>10%), persistent diarrhea, persistent fever (>38 °C) for more than 3 months, superficial lymphadenopathy and other clinical manifestations. basic knowledge The proportion of illness: 0.005% Susceptible population: pregnant women Mode of transmission: sexual transmission, blood transmission Complications: headache, diarrhea, lymphoma
Cause
Pregnancy with acquired immunodeficiency syndrome
Reduced immunity (30%):
Because the immune function of pregnant women during pregnancy is reduced, after the HIV infection during pregnancy, the disease develops more rapidly and the symptoms are heavier.
Virus infection (30%):
HIV can cause intrauterine infection through the placental blood circulation, and birth canal secretions, blood, and postpartum breastfeeding during childbirth can also infect newborns.
Autologous infection (30%):
HIV-infected pregnant women can be transmitted to the fetus through the placenta during pregnancy. Or newborns born through soft birth canal and breastfeeding after birth.
Prevention
Pregnancy with acquired immunodeficiency syndrome prevention
The precautionary principle is to avoid direct contact with HIV-infected people's blood, saliva, tears, milk, urine, feces, semen and vaginal secretions. Specific measures include:
1. Strengthen sexual knowledge related to HIV and AIDS, health education for sexual behavior, cleanse yourself, prevent sexual contact with HIV-infected people, and avoid sexual contact with human immunodeficiency virus.
2. Prevent the spread of the injection route.
3. Strengthen blood product management.
4, female HIV-infected persons, especially those infected with HIV-1 should try to avoid pregnancy to prevent mother-to-child transmission.
Complication
Pregnancy with acquired immunodeficiency syndrome complications Complications, headache, diarrhea, lymphoma
Opportunistic infection
(1) Protozoal infection:
1 Toxoplasmosis: often have headache, fever, meningoencephalitis, retinal choroiditis, etc., the diagnosis mainly depends on the detection of anti-toxoplasma IgM antibody (+) or skull CT in the blood see typical ring-shaped lesions.
2 Cryptosporidium enteritis: mainly diarrhea, watery stools, sometimes a lot, can cause dehydration and electrolyte imbalance.
(2) bacterial infection:
Gram-positive cocci and Gram-negative bacilli are often secondary to some complications. The most common are Mycobacterium tuberculosis and Mycobacterium avium. The clinical tuberculosis progresses rapidly, and the cavity and sputum are positive. The treatment is difficult and the whole body is broadcast. Disseminated tuberculosis.
(3) Fungal infections:
1 common oral candida infection, also has esophageal tracheal or colonic candida infection;
2 Pneumocystis carinii pneumonia: In recent years, the DNA of Pneumocystis carinii has been found to be more like a fungus, so it is classified as a fungal infection. Mainly manifested as low fever, dry cough and less phlegm, increased difficulty after breathing difficulties, physical examination with mild purpura, occasional snoring sounds in both lungs, rarely smelling wet sputum, blood oxygen partial pressure drops significantly, chest surface visible lung texture increased , or patch shadows, in severe cases, the two lungs have large fused shadows in the shape of a glass, if the fiberoptic bronchoscopy lavage fluid can be found in the Pneumocystis trophozoites and cysts; 3 cryptococcal meningitis and histoplasma Or systemic infection of penicillin is also reported frequently.
(4) Viral infection:
Infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), herpes zoster virus (HZV), cytomegalovirus (CMV), and EB virus can be seen.
2. Malignant tumor
(1) Kaposi's sarcoma: It can be seen on the skin or mucous membrane including the lungs and esophagus. The diagnosis requires biopsy for pathological examination.
(2) lymphoma: often have persistent fever, systemic lymphadenopathy, diagnosis also depends on biopsy to send pathology. 3. Common malnutrition Due to fever, diarrhea, various infections or excessive tumor consumption, and patients with loss of appetite, long time will cause malnutrition and even dyscrasia.
Symptom
Pregnancy with acquired immunodeficiency syndrome symptoms Common symptoms HIV infection lymph node enlargement is inevitable premature birth threatened premature delivery
Because the immune function of pregnant women during pregnancy is reduced, after the HIV infection during pregnancy, the disease develops more rapidly and the symptoms are heavier. Patients may have significant fever, fatigue, night sweats, uncontrollable weight loss (>10%), persistent diarrhea, persistent fever (>38 °C) for more than 3 months, superficial lymphadenopathy and other clinical manifestations.
Examine
Pregnancy with acquired immunodeficiency syndrome
Laboratory tests for HIV infection must rely on laboratory tests. HIV should be tested in high-risk groups: steroid detection, HIV-positive can be diagnosed as acute HIV infection. Without any clinical manifestations, HIV antibody was positive, the total number of CD4 lymphocytes was normal, CD4/CD8 value was >1, and serum p24 antigen negative should be diagnosed as asymptomatic HIV infection. In addition to having an epidemiological history and clinical manifestations, the diagnosis of AIDS should be positive for anti-HIV antibodies and the total number of CD4 lymphocytes.
Diagnosis
Diagnosis and identification of pregnancy-acquired immunodeficiency syndrome
diagnosis
Ask the medical history in detail, according to the high-risk group, there are diseases that are not easily affected by ordinary people. It is not difficult to diagnose the disease. Pathogen testing is the primary means of identification.
Differential diagnosis
The clinical manifestations of this disease are complex and diverse, and are easily confused with many diseases.
1. The acute phase of the disease should be differentiated from infectious mononucleosis and other infectious diseases such as tuberculosis and connective tissue diseases.
2. Lymph node enlargement should be differentiated from blood system diseases, especially with benign sexual lymphadenopathy syndrome. The latter lymph node biopsy is benign reactive follicular hyperplasia, and serological examination suggests multiple viral infections.
3. The immunodeficiency change of this disease must be differentiated from congenital or secondary immunodeficiency disease.
