Approximately 10 percent of the world population is infected with Entamoeba histo6ltica, and most are asymptomatic (Andrade, 201r5). Amebic dysentelY, however, may take a fulminant course during pregnancy, with fever, abdominal pain, and bloody stools. Prognosis is worse if complicated by a hepatic abscess. Diagnosis is made by identiying E histoytica cysts or trophozoites within a stool sample. herapy is similar to that for the nonpregnant woman, and metronidazole or tinidazole are the preferred drugs for amebic colitis and invasive disease. Noninvasive infections may be treated with iodoquinol or paromomycin.
Disseminated fungal infection-usually pneumonitis-during pregnancy is uncommon with coccidiomycosis, blastomycosis, cryptococcosis, or histoplasmosis. heir identification and management are considered in Chapter 51 (p. 995).
Pregnant travelers face general medical, obstetrical, and potentially hazardous destination risks. Several sources provide travel information (Freedman, 2016). he International Federation for Tropical Medicine has comprehensive information available at ww.iftm-hp.org, and the International Society of Travel Medicine publishes information at www.istm.org/ bodyofknowledge. lso, 1he Yelow Book, mentioned earlier, by the CDC has extensive travel information regarding pregnancy and breastfeeding.
The concept ofbioterrorism involves the deliberate release ofbacteria, viruses, or other infectious agents to cause illness or death. hese natural agents are often altered to increase their infectivity or their resistance to medical therapy. Health-care providers should be alert for signiicant increases in the number of persons with febrile illnesses accompanied by respiratory symptoms or with rashes not easily associated with common illnesses. Clinicians are urged to contact their state health department or the CDC for current information and recommendations. The merican College of Obstetricians and Gynecologists (2016a) has addressed disaster preparedness for obstetricians. It provides both general considerations and recommendations for hospital readiness and obstetrics-specific issues.
he variola virus causes smallpox and is considered a serious weapon. The virus is highly transmissible and carries an overall 30-percent case-fatality rate. The last case of smallpox in the United States was reported in 1949, and worldwide it was reported in Somalia in 1977. Nishiura (2006) has reviewed the severe perinatal and maternal morbidity and mortality caused by smallpox. The case-fatality rate of smallpox in pregnancy is 61 percent if the pregnant woman is unvaccinated. Rates of stillbirth, abortion, preterm labor and delivery, and neonatal demise rise significantly in pregnancies complicated by this infection.
Because the smallpox vaccine currently available is made with live vaccinia virus, pregnancy should be delayed for 4 weeks in recipients. It is generally not given to pregnant women because of the risk of fetal vaccinia, a rare but serious complication. Inadvertent smallpox vaccination during pregnancy has not, however, been convincingly associated with fetal malformations or preterm birth (Badell, 2015). Moreover, no cases of fetal vaccinia have been reported with second-generation smallpox vaccine exposure. The Smallpox Vaccine in Pregnancy Registry remains active, and vaccinated women are still being enrolled: DOD .NHRC-birthregistry@mail.mil.