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

YEON-SOOK KIM Division of Infectious Diseases, Department of Internal Medicine, Department of Pediatrics, and Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Republic of Korea; and Korea Center for Disease Control and Prevention, Seoul, Republic of Korea

Search for other papers by YEON-SOOK KIM in
Current site
Google Scholar
PubMed Close
,
HYO JIN LEE Division of Infectious Diseases, Department of Internal Medicine, Department of Pediatrics, and Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Republic of Korea; and Korea Center for Disease Control and Prevention, Seoul, Republic of Korea

Search for other papers by HYO JIN LEE in
Current site
Google Scholar
PubMed Close
,
MEAYOUNG CHANG Division of Infectious Diseases, Department of Internal Medicine, Department of Pediatrics, and Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Republic of Korea; and Korea Center for Disease Control and Prevention, Seoul, Republic of Korea

Search for other papers by MEAYOUNG CHANG in
Current site
Google Scholar
PubMed Close
,
SUNG KYONG SON Division of Infectious Diseases, Department of Internal Medicine, Department of Pediatrics, and Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Republic of Korea; and Korea Center for Disease Control and Prevention, Seoul, Republic of Korea

Search for other papers by SUNG KYONG SON in
Current site
Google Scholar
PubMed Close
,
YUN EE RHEE Division of Infectious Diseases, Department of Internal Medicine, Department of Pediatrics, and Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Republic of Korea; and Korea Center for Disease Control and Prevention, Seoul, Republic of Korea

Search for other papers by YUN EE RHEE in
Current site
Google Scholar
PubMed Close
, and
SOO KYONG SHIM Division of Infectious Diseases, Department of Internal Medicine, Department of Pediatrics, and Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Republic of Korea; and Korea Center for Disease Control and Prevention, Seoul, Republic of Korea

Search for other papers by SOO KYONG SHIM in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.4269/ajtmh.2006.75.955
Volume/Issue:
Volume 75: Issue 5
Page(s):
955–959
Restricted access
Get Permissions

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.

Author Notes

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@cnuh.co.kr.
Copyright:
Copyright 2006 The American Society of Tropical Medicine 2006
Received:
24 May 2006
|
Accepted:
02 Jun 2006
|
Published Online:
Nov 2006
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
  • 1

    Oaks SC Jr, Ridgway RL, Shirai A, Twartz JC, 1983. Scrub Typhus. Bulletin No. 21. Kuala Lampur, Malaysia: Institute for Medical Research.

    • PubMed
    • Export Citation
  • 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.

    • PubMed
    • Export Citation
  • 3

    Korea Center for Disease Control and Prevention, 2005. CDMR Commun Dis Monthly Rep 16 :237.

  • 4

    Berman SJ, Kundin WD, 1973. Scrub typhus in South Vietnam: a study of 87 cases. Ann Intern Med 79 :26–30.

  • 5

    World Health Organization. WHO Recommended Surveillance Standards. Second edition. Accessed May 15, 2006. Available from http://www.who.int/emc.

    • PubMed
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Physicians’ Desk Reference, 2006. Sixtieth edition. Montvale, NJ: Thomson, 1859–1861.

    • PubMed
    • Export Citation
  • 10

    Briggs G, Freeman RK, Yaffe SJ, 1986. Drugs in Pregnancy and Lactation. Second edition. Baltimore, MD: Williams & Wilkins, 76–78.

    • PubMed
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Physicians’ Desk Reference, 2006. Sixtieth edition. Montvale, NJ: Thomson, 2568–2571.

    • PubMed
    • Export Citation
  • 13

    Choi E, Pai H, 1998. Azithromycin therapy for scrub typhus during pregnancy. Clin Infect Dis 27 :1538–1539.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Wang CL, Yang KD, Cheng SN, Chu ML, 1992. Neonatal scrub typhus: a case report. Pediatrics 89 :965–968.

  • 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.

  • 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.

  • 18

    Alvarez-Elcoro S, Enzler MJ, 1999. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc 74 :613–634.

  • 19

    Van Bambeke F, Tulkens PM, 2001. Macrolides: pharmacokinetics and pharmacodynamics. Int J Antimicrob Agents 18 (Suppl1):S17–S23.

  • 20

    McClain JB, Joshi B, Rice R, 1988. Chloramphenicol, gentamicin, and ciprofloxacin against murine scrub typhus. Antimicrob Agents Chemother 32 :285–286.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Seilmaier M, Guggemos W, Bohme CC, Loscher T, 2004. Tsutsugamushi fever after travel to Southeast Asia. Dtsch Med Wochenschr 129 :2233–2235.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

  • 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.

Past two years Past Year Past 30 Days
Abstract Views 2633 1833 208
Full Text Views 993 18 1
PDF Downloads 516 17 0
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save