Abstract
BackgroundThere is a paucity of published reports on pregnancy outcome following scrub and murine typhus despite these infections being leading causes of undifferentiated fever in Asia. This study aimed to relate pregnancy outcome with treatment of typhus.Methodology/Principal FindingsData were analyzed from: i) pregnant women with a diagnosis of scrub and/or murine typhus from a fever cohort studies; ii) case series of published studies in PubMed using the search terms “scrub typhus” (ST), “murine typhus” (MT), “Orientia tsutsugamushi”, “Rickettsia tsutsugamushi”, “Rickettsia typhi”, “rickettsiae”, “typhus”, or “rickettsiosis”; and “pregnancy”, until February 2014 and iii) an unpublished case series. Fever clearance time (FCT) and pregnancy outcome (miscarriage and delivery) were compared to treatment. Poor neonatal outcome was a composite measure for pregnancies sustained to 28 weeks or more of gestation ending in stillbirth, preterm birth, or delivery of a growth restricted or low birth weight newborn.ResultsThere were 26 women in the fever cohort. MT and ST were clinically indistinguishable apart from two ST patients with eschars. FCTs (median [range] hours) were 25 [16–42] for azithromycin (n = 5), 34 [20–53] for antimalarials (n = 5) and 92 [6–260] for other antibiotics/supportive therapy (n = 16). There were 36.4% (8/22) with a poor neonatal outcome.In 18 years, 97 pregnancies were collated, 82 with known outcomes, including two maternal deaths. Proportions of miscarriage 17.3% (14/81) and poor neonatal outcomes 41.8% (28/67) were high, increasing with longer FCTs (p = 0.050, linear trend). Use of azithromycin was not significantly associated with improved neonatal outcomes (p = 0.610)ConclusionThe published ST and MT world literature amounts to less than 100 pregnancies due to under recognition and under diagnosis. Evidence supporting the most commonly used treatment, azithromycin, is weak. Collaborative, prospective clinical trials in pregnant women are urgently required to reduce the burden of adverse maternal and newborn outcomes and to determine the safety and efficacy of antimicrobial treatment.
Highlights
The true burden of scrub typhus (ST) and murine typhus (MT) in South-east Asia remains largely unknown as diagnostic tests are rarely used or available [1]
Studies showing that the malaria vector An. gambiae mosquitoe was more attracted to pregnant women than non-pregnant women [3], have not been performed with the vectors of ST and MT
Typhus was confirmed by PCR [25,26,27,28] and/or in vitro isolation of Rickettsia spp. [29] and/or positive reference serology measured by four-fold rise in paired sera IFA [30,31] to define acute infection as MT (Rickettsia typhi) or ST (Orientia tsutsugamushi)
Summary
The true burden of scrub typhus (ST) and murine typhus (MT) in South-east Asia remains largely unknown as diagnostic tests are rarely used or available [1]. No data suggests that typhus occurs more or less commonly in pregnancy. There is a scatter of small case series and reports on ST and MT [4,5,6,7,8,9,10,11,12,13,14,15,16] which tend to suggest serious repercussions for the mother and fetus, and congenital transmission has been reported [10,11]. There is a definitive lack of new studies or data in the published literature with a four year gap between the two latest publications. There is a paucity of published reports on pregnancy outcome following scrub and murine typhus despite these infections being leading causes of undifferentiated fever in Asia. This study aimed to relate pregnancy outcome with treatment of typhus
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
