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SCRUB TYPHUS DURING PREGNANCY AND ITS TREATMENT: A CASE SERIES AND REVIEW OF THE LITERATURE

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.

Received May 24, 2006. Accepted for publication June 2, 2006.

Acknowledgment: We thank Philip McElroy for proofreading the manuscript.

Financial support: This study was supported by Chungnam National University Hospital (Daejeon, Republic of Korea).

^* Address correspondence to Yeon-Sook Kim, Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Hospital, 640 Daesa-dong, Jung-gu, Daejeon 301-721, Republic of Korea. E-mail: alice{at}cnuh.co.kr

Authors’ addresses: Yeon-Sook Kim and Hyo Jin Lee, Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Hospital, 640 Daesa-dong, Jung-gu, Daejeon 301-721, Republic of Korea. Meayoung Chang, Department of Pediatrics, Chungnam National University Hospital, 640 Daesa-dong, Jung-gu, Daejeon 301-721, Republic of Korea. Sung Kyong Son and Yun Ee Rhee, Department of Obstetrics and Gynecology, Chungnam National University Hospital, 640 Daesa-dong, Jung-gu, Daejeon 301-721, Republic of Korea. Soo Kyoung Shim. Division of Rickettsial and Zoonotic Diseases, Department of Bacteriology, National Institute of Health, Korea Center for Disease Control and Prevention, 5 Nokbeon-Dong, Eunpyeong-Gu, Seoul, Republic of Korea.

Reprint requests: Yeon-Sook Kim, Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Hospital, 640 Daesa-dong, Jung-gu, Daejeon 301-721, Republic of Korea, Telephone: 82-42-259-8109, Fax: 82-42-257-5753, E-mail: alice{at}cnuh.co.kr.