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CASE REVIEW INFEKSI TORCH

KASUS
PAGE 1-1
Mrs.Rifi, aged 26 years old, is expecting her second baby. Her first son was born
healthy 3 years ago, but she is worried now because she just watched a TV program
pf infectious disease in pregnancy. She is her 16 th week of pregnancy and all this time
she was in perfect health. She has done some routine laboratory exams which were
normal, but has never run any test for TORCH. She fears that she might catch the
disease in her pregnancy.
PAGE 1-2
The physical examination shows :
Vital sign and general physical findings are within normal limit.
Obstetric examination :
Fundal height : midway from symphysis to umbilicus
Ballottement : positive
Fetal heart sound normal
Ultrasound examination shows :
A singleton baby with biparietal diameter and head circumference equal
to 16 weeks
No signs of enlargement of the lateral-ventricles
Spines were normal
Other findings within normal limit
Additional lab test :
Toxoplasma IgG (+)
Toxoplasma IgM positive (titration 1 / 512)
IgG Avidity (+)

PAGE 2-1
Mrs.Rifi was on Spiramycin therapy under close supervision by her physician. She
had repeated ultrasound scanning and the baby was found normal. Reaching 38
weeks pregnancy she delivered her baby spontaneously, giving birth to a male of
2500 grams (birth weight) and 46 cm (height). She is recovering well.
PAGE 2-2
Physical examination of the baby reveals :

General condition : not doing well

Generised ptechiae
Head circumference : 34 cm
Large fontanel : normal
Temperature : 39.2 o C
Respiration : 70 times per minutes, mild retraction in the intercostals space
Eye : icteric sclera
Mild nasal flare
Hearth rate : 170 bpm
Lungs : normal
Abdomen : distended
Liver : 4 cm below costal ridge
Spleen : schuffner 1

Laboratory :

Hb :11 gr/dL
Leukocyte : 24.000 / mm3
Different ciunt : 0/2/8/30/58/2
Platelet count : 100.000 / mm3
Packed cell volume : 33 %
Blood smear : red blood cell hypocrom, microcyter
White blood cells : no cellular changes
SGOT (AST) : 65 u/L
SGPT (ALT) : 70 u/L
Urine : within normal limit

Toxoplasm IgM : (-)

Toxplasm IgG : (-)
PCR for Toxoplasma : (+)
PAGE 2-3
After the treatment with Pyrimethamine plus sulfonamide in alternate with
Spiondition. After ramysin every 3 weeks, and in addition with Folic acid
administration, the baby was in a stable condition. After 1 month of treatment, the
patient showed absence of fever, respiratory distress, nor seizure. The baby was also
consulted to ophthalmology department, there was no ophthalmologic abnormalities
concerning the presence of retinal scars and macular lesions. Neurological
examination performed at age 4 months was normal.
PAGE 3-1
EPILOGUE
The boy survived and now he is a 9 year healthy boy. The parents learnt noe that
when they expect their third pregnancy, genetic counseling ang pre conceptional
counseling by a team work is compulsory, which consist of gynecologist, cellular and
molecular biologist as well as psychologist.

Mrs.Rifi , 26 th , G0P1A0
Khawatir anaknya terinfeksi TORCH

ANAMNESIS :

PX.FISIK IBU :

PX.OBSTETRIK :

PX USG :

PX LAB IBU :

Pemeriksaan
lab rutin
normal.

VT : NORMAL

Tinggi fundus :
2 jari di atas
simfisis.

Diameter
biparietal
sesuai umur
kehamilan.

Toxo IgG : (+)

KU : NORMAL

Belum pernah
menjalani tes
untuk TORCH

Ballottement :
(+)
DJJ : NORMAL
FISIK IBU
NORMAL

TORCH :
Definisi
Etiologi

Hamil 16 minggu

Tidak ada
perbesaran
lateral
ventrikel.
Tulang
belakang :
NORMAL

Amnion NORMAL

Epidemiologi
Klasifikasi
Pathogenesis ,
patofisologi
Faktor resiko
Menifestasi
klinik
Diagnose
Komplikasi
terapi

JANIN
NORMAL

Toxo IgM : (+)

titration 1 /
152)
IgG avidity :
(+)

IBU
TOXOPLASM
A AKUT

TERAPI
SPIRAMICIN

Bayi Mrs.Rifi ( O )

PX FISIS :

PX LAB :

TERAPI :

Ptec hiae

Hb

Temperature

Leukosit

Mata

Different count

Pyrimethamin +
sulfonamide bergantian
dengan spiramycin + asam
folat per 3 minggu
bergantian.

Respirasi

Platelet count

Abdomen : hepar dan

spleen

Packed cell volume

Neurological
Ophthalmology

Blood smear
White blood cells
SGOT
SGPT
Urine
Toxo IgM
Toxo IgG
PCR for toxoplasma

Bayi laki-laki Mrs Rifi bertahan dan kini menjadi seorang anak laki-laki
berusia 9 tahun yang sehat.

ANALISA KASUS
Pada kasus ini, dalam pemeriksaan laboratorium bayi Ny,Rifi hasilnya adalah :
bila IgG (-) dan IgM (-)
Belum pernah terinfeksi dan beresiko untuk terinfeksi.
Bila sedang hamil, perlu dipantau setiap 3 bulan pada sisa kehamilan (dokter
mengetahui kondisi dan kebutuhan pemeriksaan anda).
Lakukan tindakan pencegahan agar tidak terjadi infeksi.
PCR (polymerase chain reaction) merupakan suatu teknik atau metode perbanyakan
DNA secara enzimatik . (termasuk DNA toxoplasma)
Jadi apabila hasilnya (+) maka terdapat DNA virus toxoplasma.
Maka, dapat kita simpulkan bahwa bayi Ny.Rifi sudah terinfeksi toxoplasma dari
ibunya.
KESIMPULAN
Kehamilan tidak mengubah daya tahan tubuh seorang wanita terhadap infeksi.
Namun, keparahan setiap infeksi berkorelasi positif dengan efeknya pada
janin.
Infeksi mempunyai efek tidak langsung dan langsung pada janin. Efek tidak
langsung timbul karena mengurangi oksigensi darah plasenta dan mengganggu
pertukaran nutrisi melalui plasenta. Efek langsung tergantung pada
kemampuan organisme penyebab menembus plasenta dan menginfeksi janin.
Secara anatomik dan fisiologik ibu hamil juga mengalami perubahan, sehingga
mempermudah terjadinya infeksi.
Infeksi bisa disebabkan oleh bakteri, virus, dan parasit, sedangkan penularan
dapat terjadi intrauterine pada waktu persalinan / pascalahir. Transmisi bisa
secara transplasenta / melalui aliran darah / cairan amnion.