Abstract
Background
Scrub typhus is rare in pregnancy, but it has now become an important cause of febrile illness in pregnancy in sub-Himalayan region of India. Only a few case reports have been published so far, and they show adverse maternal and fetal outcomes. No consensus has been reached till now regarding treatment.
Methodology
All the pregnant patients irrespective of period of gestation admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed using a detailed history of symptoms, travel, recreation, agricultural activities, treatment record prior to admission, and a detailed examination, and the treatment outcome was noted. Fever workup including cultures, CXR, CSF analysis, serology for scrub was done. IgM scrub typhus was done by kit method manufactured by InBios Intertational, Inc.
Results
We observed in total 14 pregnant patients out of which eight were in the the second trimester and six were in the third trimester. The clinical features of the disease observed for pregnant females were the same as for nonpregnant females. There was no difference in the severity of scrub typhus between pregnant and nonpregnant women. No mortality was found in these patients. On follow-up, they had normal peripartum and postpartum periods. All were treated with azithromycin 500 mg once a day for 5 days.
Conclusion
Although rare, scrub typhus should be considered in differential diagnosis of fever in pregnant patients especially in scrub season. Azithromycin should be the drug of choice in pregnancy as it has no adverse effect on fetus and pregnancy outcome.
Similar content being viewed by others
References
Pal LS, Sharma V, Mahajan SK, et al. Scrub typhus in Himalayas. Emerg Infect Dis. 2006;12:1–6.
Sharma P, Kakkar R, Kaore SN, et al. Geographical distribution, effect of season and life cycle of scrub typhus. JK Sci. 2010;12:63–5.
Guerrant RL, Watt G, Walker DH. Tropical infectious diseases principles, pathogens and practice, vol. 2. Philadelphia: Churchill Livingstone Elsevier; 2006. pp. 52–56.
Kim YS, Yun HJ, Shim SK, et al. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis. 2004;39:1329–35.
Kim YS, Lee HJ, Chang M, et al. Scrub typhus during pregnancy and its treatment: a case series and review of the literature. Am J Trop Med Hyg. 2006;75:955–9.
Mahajan R, Singh NR, Kapoor V. Antibiotic use in scrub typhus: systematic review and meta- analysis of clinical trials. JK Sci. 2010;12:92–4.
Kim ES, Chung MH, Kang JS. Treatment of scrub typhus during pregnancy: review of Korean patients. Infect Chemother. 2010;40:130–1.
Phupong V, Srettekraikul K. Scrub typhus during pregnancy: a case report and review of literature. Southeast Asian J Trop Med Public Health. 2004;35:358–60.
Antibiotics for treating scrub typhus (review). The cochrane collaboration. John willey and Sons LTD; 2010. doi:10.1002/14651858.CD002150.
Mathai E, Rolain JM, Verghese L, et al. Scrub typhus during pregnancy in India: a case report. Trans R Soc Trop Med Hyg. 2003;97:570–2.
Mahajan SK, Rolain JM, Thakur S, et al. Scrub typhus complicating pregnancy. JAPI. 2009;57:720–1.
Poomalar GK, Rekha R. A case series of scrub typhus in obstetrics. J Clin Diagn Res. 2014;8:1–3.
Phupong V. Pregnancy and scrub typhus. JK Sci. 2010;12:85–7.
Funding
This has not been sponsored by any organization.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Ritesh Kumar, Surinder Thakur, Rajesh Bhawani, Anil Kanga and Asha Ranjan declare that they have no conflicts of interest.
Ethical approval
Study conducted was in accordance to the ethical standards of the responsible committee on human study and with the Helsinki declaration of 1975, as revised in 2008.
Informed consent
Informed consent was obtained from all the patients for being included in the study.
Additional information
Dr. Ritesh Kumar is a Senior Resident in the Department of Cardiology, IGMC Shimla, Shimla, India; Dr. Surinder Thakur is a Professor, Dr. Rajesh Bhawani is an Associate Professor in the Department of Medicine, IGMC Shimla, Shimla, India; Dr. Anil Kanga is a Professor in the Department of Microbiology, IGMC Shimla, Shimla, India; Dr. Asha Ranjan is a Senior Resident in the Department of Medicine, IGMC Shimla, Shimla, India.
Rights and permissions
About this article
Cite this article
Kumar, R., Thakur, S., Bhawani, R. et al. Clinical Profile of Scrub Typhus in Pregnancy in Sub-Himalayan Region. J Obstet Gynecol India 66 (Suppl 1), 82–87 (2016). https://doi.org/10.1007/s13224-015-0776-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13224-015-0776-8