Scrub Typhus During Pregnancy and Its Treatment: A Case Series and Review of the Literature

Abstract

Abstract. Although scrub typhus is uncommon in pregnant women, when present, it can have serious repercussions for the mother and developing fetus. Since it is uncommon, the clinical impact of scrub typhus on pregnancy has not been elucidated and an effective and safe therapeutic regimen has not been validated. The medical records of pregnant women whose scrub typhus were treated at Chungnam National University Hospital were reviewed and their clinical outcomes were evaluated. A review of the literature was also performed on pregnant women with scrub typhus and their clinical outcomes. Eight pregnant women with scrub typhus were treated successfully with a single 500-mg dose of azithromycin, and no relapses were reported. They all delivered healthy babies at term, without congenital or neonatal complications. In the reviews, azithromycin was effective against scrub typhus and had favorable pregnancy outcomes. Ciprofloxacin and cefuroxime failed to treat scrub typhus and fetal loss resulted. A single 500-mg dose of azithromycin may be a reasonable treatment regimen for pregnant women with scrub typhus. Ciprofloxacin might not be advisable for the treatment of scrub typhus during pregnancy. Scrub typhus itself seems to have serious adverse effects on pregnancy if not appropriately controlled.

Clinical Profile of Scrub Typhus in Pregnancy in Sub-Himalayan Region

“…Complication rates were also similar. This is in accordance with other studies [3,5,8] No mortality was found in these patients. ARDS, severe sepsis, MODS, and septic shock were present more in patients presenting in the second trimester.…”

“…We followed the regimen which has been recommended in our institution. A study by Kim et al from Korea has reported nine cases of scrub typhus in pregnancy treated with single dose of azithromycin [5]. However, it does not mention the treatment given to patient with severe complications.…”

“…Those treated with ciprofloxacin and cefuroxime did not respond, and still-births were observed. Patients receiving chloramphenicol and tetracycline responded to treatment, but adverse pregnancy outcomes in the form of still-birth and fetal loss were seen [5]. Cochrane's drug review for scrub typhus also fails to recommend treatment for this subgroup of scrub typhus patients [9].…”

“…Only few case reports and case series have been published so far. Diagnosis of scrub typhus during pregnancy is the same as in nonpregnant women There has been reports that scrub typhus may lead to spontaneous abortion, stillbirth, preterm delivery and small for gestational age infants but still exact impact in final maternal and fetal outcome is still unclear [4,5]. Doxycycline continues to be the standard therapy for scrub typhus in nonpregnant adults; however, being a class D drug according to the U.S. Food and Drug Administration (FDA), it is contraindicated in pregnant women.…”

“…Doxycycline continues to be the standard therapy for scrub typhus in nonpregnant adults; however, being a class D drug according to the U.S. Food and Drug Administration (FDA), it is contraindicated in pregnant women. Azithromycin has been reported to effectively cure scrub typhus in pregnant women and showed favorable pregnancy outcomes [5][6][7]. Till date, no other study based on IgM ELISA from sub-Himalayan region has described the clinical profile and outcome of scrub typhus in pregnant females.…”