2018 FSA Posters
P055: NEURAXIAL ANESTHESIA IN THE SETTING OF UNKNOWN PARASITIC INFECTION IN THE OTHERWISE HEALTHY PARTURIENT
Reena John, DO, Jack Guevara, DO, Crystal Lam, MD, Carlos Rodriguez, MD; Kendall Regional Medical Center
21 yo G1P0 F, at term, in labor pain requesting epidural anesthesia for 3rd trimester labor pain.
VS: BP: 86/52 HR: 124 RR:22 O2%: 100 RA
GEN: AAO x 3, NAD
RESP: CTAB, labored breathing
CVS: sinus tachycardia, NL S1S2
OB/GYN: appears to be 37 weeks pregnant, FHR 130s
21 yo G1P0 F, at term, in labor pain requesting epidural anesthesia for 3rd trimester labor pain. Pt reports a 6 month history of parasites in her stools and a bi/triweekly perirectal pruritis. Patient works in quality control examining plants, flowers, and produce. She denies recent travel history, contact with children, or exposure to underbooked meat. Infectious disease is following the patient and stool studies and workup are pending. Scotch tape test negative. Patient is requesting epidural for 3rd trimester labor pains.
Pt reports a 6 month history of parasites in her stools and a bi/triweekly perirectal pruritis. Workup in progress, and species of parasitic infection unknown. Some species of parasites are known to enter the bloodstream as part of their life cycle. Due to the risk of hematogenic spread and potential entrance into the CSF (and possibly brain) from any trauma during epidural or spinal placement, the benefit of neuraxial anesthesia did not outweigh the potential neurologic squelae that could ensue if the parasite were to breach the blood brain barrier. Per the OB/GYN pt required emergent C-section. In the setting of unknown parasitic infection, general anesthesia was administered to avoid potential spread of parasitic infection into the cerebrospinal fluid. Patient was an easy intubation, which an uneventful cesearean section. The patient delivered a 7lb 4 oz baby boy, Apgar 9/9. Eosinophilia was seen in labs. Patient was treated with one dose of albendazole and instructed not to breastfeed for 48 hours.
- Parasitic infection of the nervous system can produce a variety of symptoms and signs.
- Because symptoms of infection are often mild or nonspecific, diagnosis can be difficult.
- Some of the more common infections of the nervous system caused by cestodes, trematodes and protozoans: Echinococcus spp., Spirometra spp. (sparganosis), Paragonimus spp., Schistosoma spp., Trypanosoma spp., Naegleria fowlerii, Acanthamoeba histolytica, and Balamuthia mandrillaris.
- Parasites have been implicated in the formation of epidural abscesses which can lead to neurological deficits.
- Cases have been reported in which parturients have undergone neuraxial anesthesia with known parasitic infections without complications or sequelae.
In the setting of very limited research, it is better to err on the side of caution and avoid neuraxial procedures
- The risk of potential neurological complications and sequelae outweigh the benefits of neuraxial anesthesia