Emergency caesarean delivery in a patient with cerebral mala
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Abstract :
Malaria-leptospira co-infection is rarely detected. Emergency surgery in such patients has not been reported. We describe such a case of a 24-year-old primigravida at term pregnancy posted for emergency caesarean delivery who developed pulmonary haemorrhage, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Here, we discuss the perioperative management, pain management (with transverse abdominis plane block), intensive care management (special reference to management of pulmonary haemorrhage with intra pulmonary factor VIIa) and the role of plasmapheresis in leptospira related jaundice with renal failure.

Case :
A 24-year-old primigravida, at 37 weeks of gestation was referred to our institute for further management on supplemental oxygen (Venturi mask) after Rapid test diagnosis of Plasmodium falciparum (Pf) malaria (ParaSight™-F, Becton Dickinson, Sparks, MD) associated with acute icteric leptospirosis (microscopic agglutination test (MAT) titers for Leptospira ictero-haemorrhagiae of 1:400). Her history revealed high grade fever, decreased urine output with yellowish discolouration and altered sensorium. She was disoriented, febrile and icteric and had sub-conjunctival haemorrhages and fine basal crepitations on auscultation. She was receiving intravenous (i.v.) artesunate and ceftriaxone and doxycycline capsules.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968654/
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