Volume 75, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Oaks SC Jr, Ridgway RL, Shirai A, Twartz JC, 1983. Scrub Typhus. Bulletin No. 21. Kuala Lampur, Malaysia: Institute for Medical Research.
  2. Roult D, 2005. Scrub typhus. Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Sixth edition. Volume 2. Philadelphia: Churchill Livingstone, 2309–2310.
  3. Korea Center for Disease Control and Prevention, 2005. CDMR Commun Dis Monthly Rep 16 : 237. [Google Scholar]
  4. Berman SJ, Kundin WD, 1973. Scrub typhus in South Vietnam: a study of 87 cases. Ann Intern Med 79 : 26–30. [Google Scholar]
  5. World Health Organization. WHO Recommended Surveillance Standards. Second edition. Accessed May 15, 2006. Available from http://www.who.int/emc.
  6. Watt G, Kantipong P, Jongsakul K, Watcharapichat P, Phulsuksombati D, 1999. Azithromycin activities against Orientia tsutsugamushi strains isolated in cases of scrub typhus in northern Thailand. Antimicrob Agents Chemother 43 : 2817–2818. [Google Scholar]
  7. Mathai E, Rolain JM, Verghese L, Mathai M, Jasper P, Verghese G, Raoult D, 2003. Case reports: scrub typhus during pregnancy in India. Trans R Soc Trop Med Hyg 97 : 570–572. [Google Scholar]
  8. Phupong V, Srettakraikul K, 2004. Scrub typhus during pregnancy: a case report and review of the literature. Southeast Asian J Trop Med Public Health 35 : 358–360. [Google Scholar]
  9. Physicians’ Desk Reference, 2006. Sixtieth edition. Montvale, NJ: Thomson, 1859–1861.
  10. Briggs G, Freeman RK, Yaffe SJ, 1986. Drugs in Pregnancy and Lactation. Second edition. Baltimore, MD: Williams & Wilkins, 76–78.
  11. Kim YS, Yun HJ, Shim SY, Koo SH, Kim SY, Kim S, 2004. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis 39 : 1329–1335. [Google Scholar]
  12. Physicians’ Desk Reference, 2006. Sixtieth edition. Montvale, NJ: Thomson, 2568–2571.
  13. Choi E, Pai H, 1998. Azithromycin therapy for scrub typhus during pregnancy. Clin Infect Dis 27 : 1538–1539. [Google Scholar]
  14. Tsui MS, Fang RCY, Su YM, Li YT, Lin HM, Sun LS, Tu FC, 1992. Scrub typhus and pregnancy: a case report and literature review. Zhonghua Yi Xue Za Zhi (Taipei) 49 : 61–63. [Google Scholar]
  15. Wang CL, Yang KD, Cheng SN, Chu ML, 1992. Neonatal scrub typhus: a case report. Pediatrics 89 : 965–968. [Google Scholar]
  16. Suntharasaj T, Janjindamai W, Krisanapan S, 1997. Pregnancy with scrub typhus and vertical transmission: a case report. J Obstet Gynaecol Res 23 : 75–78. [Google Scholar]
  17. McDonald HN, Good W, 1972. The effect of parity on plasma sodium, potassium, chloride and osmolality levels during pregnancy. Br J Obstet Gynaecol 72 : 173. [Google Scholar]
  18. Alvarez-Elcoro S, Enzler MJ, 1999. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc 74 : 613–634. [Google Scholar]
  19. Van Bambeke F, Tulkens PM, 2001. Macrolides: pharmacokinetics and pharmacodynamics. Int J Antimicrob Agents 18 (Suppl1) : S17–S23. [Google Scholar]
  20. McClain JB, Joshi B, Rice R, 1988. Chloramphenicol, gentamicin, and ciprofloxacin against murine scrub typhus. Antimicrob Agents Chemother 32 : 285–286. [Google Scholar]
  21. Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, Raoult D, 2003. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci 990 : 359–364. [Google Scholar]
  22. Jee HG, Chung MH, Lee SG, Kim IS, Chang WH, 1996. Transmission of scrub typhus by needlestick from a patient receiving pefloxacin. Scand J Infect Dis 28 : 411–412. [Google Scholar]
  23. Seilmaier M, Guggemos W, Bohme CC, Loscher T, 2004. Tsutsugamushi fever after travel to Southeast Asia. Dtsch Med Wochenschr 129 : 2233–2235. [Google Scholar]
  24. Loebstein R, Addis A, Ho E, Andreou R, Sage S, Donnenfeld AE, Schick B, Bonati M, Moretti M, Lalkin A, Pastuszak A, Koren G, 1998. Pregnancy outcome following gestational exposure to fluoroquiniolones: a multicenter prospective controlled study. Antimicrob Agents Chemother 42 : 1336–1339. [Google Scholar]
  25. Shirai A, Brown GW, Gan E, Huxsoll DL, Groves MG, 1981. Rickettsia tsutsugamushi antibody in mother/cord pairs of sera. Jpn J Med Sci Biol 34 : 37–39. [Google Scholar]
  26. Shirai A, Chan TC, Gan E, Groves MG, 1984. Lack of transplacental infection with scrub typhus organisms in labor mice. Am J Trop Med Hyg 33 : 285–287. [Google Scholar]

Data & Media loading...

  • Received : 24 May 2006
  • Accepted : 02 Jun 2006

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error