Supportive treatment is recommended for uncomplicated influenza, and early antiviral treatment is efective Gamieson, 2011; Oboho, 2016). Hospitalization is considered for severely ill women, and for those with pneumonia. As discussed, inluenza hospitalization rates for those with advanced pregnancy are increased compared with nonpregnant women (Dodds, 2007; Schanzer, 2007). he CDC (2016b) recommends neuraminidase inhibitors given within 2 days of symptom onset for chemoprophylaxis and treatment of influenza A and B (Chap. 64, p. 1214). he drugs interfere with release of progeny virus from infected host cells and thus prevent infection of new host cells (Cohen, 2015). Oseltamivir is given orally, 75 mg twice daily, or zanamivir is given by inhalation, 10 mg twice daily. Recommended treatment duration with either is 5 days. The drugs shorten the course of illness by 1 to 2 days, and they probably reduce the risk for pneumonitis (Belgi, 2014; Muthuri, 2014). Our practice is to treat all pregnant women with influenza whether or not pneumonitis is identiied (Rasmussen, 2014). Few data guide use of these agents in pregnant women, but the drugs are not teratogenic in animal studies and are considered low risk (Briggs, 2015).
A major potential concern for viral resistance comes from avian inluenza isolates. "Bird lu" with HPAI, H5N8, H5N2, and H5Nl isolates has been reported in the United States by the CDC Ohung, 2015). In Asia, human infection has been documented with some of these, and mortality rates are high.
Preventively, vaccination for inluenza A is recommended by the American College of Obstetricians and Gynecologists (2016b) and the CDC (2016b). Vaccination is discussed in detail in Chapter 64 (p. 1214). Prenatal vaccination also afords some temporary protection for infants (Madhi, 2014; Tita, 2016). During the 2014 to 2015 lu season, the CDC reported that only half of pregnant women received influenza vaccine (Ding,a2015).
Infection with varicella-zoster virus, the same agent responsible for chicken pox, results in pneumonitis in 5 percent of gravidas (Harger, 2002). Diagnosis and management are considered in Chapter 64 (p. 1212).
Fungal and parasitic pulmonary infections are usually of greatest consequence in immunocompromised hosts, especially in women with acquired immunodeficiency syndrome (AIDS). Of these, lung infection with Pneumoystis jiroveci, formerly called Pneumoystis carinii, is a common complication. The opportunistic fungus causes interstitial pneumonia characterized by dry cough, tachypnea, dyspnea, and difuse radiographic infiltrates. Although this organism can be identiied by sputum culture, bronchoscopy with lavage or biopsy may be necessary.
In an earlier report from the AIDS Clinical Trials Centers, Stratton and colleagues (1992) described pneumocystis pneumonia as the most frequent HIV-related disorder in pregnant women. In some cases, tracheal intubation and mechanical ventilation may be required. Ahmad and coworkers (200 I) reviewed 22 cases during pregnancy and cited a 50-percent mortality rate. Treatment is with trimethoprim-sulfamethoxazole for 14 to 21 days (Masur, 2015). Alternative agents include the more toxic pentamidine (Walzer, 2005).