title: Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border.
abstract: BACKGROUND
  Fever in pregnancy is dangerous for both mother and foetus. In the 1980's malaria was the leading cause of death in pregnant women in refugee camps on the Thai-Burmese border. Artemisinin combination therapy has significantly reduced the incidence of malaria in the population. The remaining causes of fever in pregnancy are not well documented.
  
  
  METHODS
  Pregnant women attending antenatal care, where weekly screening for malaria is routine, were invited to have a comprehensive clinical and laboratory screen if they had fever. Women were admitted to hospital, treated and followed up weekly until delivery. A convalescent serum was collected on day 21. Delivery outcomes were recorded.
  
  
  RESULTS
  Febrile episodes (n = 438) occurred in 5.0% (409/8,117) of pregnant women attending antenatal clinics from 7-Jan-2004 to 17-May-2006. The main cause was malaria in 55.5% (227/409). A cohort of 203 (49.6% of 409) women had detailed fever investigations and follow up. Arthropod-borne (malaria, rickettsial infections, and dengue) and zoonotic disease (leptospirosis) accounted for nearly half of all febrile illnesses, 47.3% (96/203). Coinfection was observed in 3.9% (8/203) of women, mostly malaria and rickettsia. Pyelonephritis, 19.7% (40/203), was also a common cause of fever. Once malaria, pyelonephritis and acute respiratory illness are excluded by microscopy and/or clinical findings, one-third of the remaining febrile infections will be caused by rickettsia or leptospirosis. Scrub and murine typhus were associated with poor pregnancy outcomes including stillbirth and low birth weight. One woman died (no positive laboratory tests).
  
  
  CONCLUSIONS
  Malaria remains the leading cause of fever in pregnancy on the Thai-Burmese border. Scrub and murine typhus were also important causes of fever associated with poor pregnancy outcomes. Febrile pregnant women on the Thai-Burmese border who do not have malaria, pyelonephritis or respiratory tract infection should be treated with azithromycin, effective for typhus and leptospirosis.
authors.affiliation: Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand. rose@shoklo-unit.com
authors.forename: Rose
authors.initials: R
authors.lastname: McGready
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Ashley
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: Saw Oo
authors.initials: SO
authors.lastname: Tan
authors.forename: Mupawjay
authors.initials: M
authors.lastname: Pimanpanarak
authors.forename: Samuel Jacher
authors.initials: SJ
authors.lastname: Viladpai-Nguen
authors.forename: Wilarat
authors.initials: W
authors.lastname: Jesadapanpong
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Blacksell
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Paris
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Day
authors.forename: Pratap
authors.initials: P
authors.lastname: Singhasivanon
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: François
authors.initials: F
authors.lastname: Nosten
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001179:Arthropod Vectors / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D015331:Cohort Studies; D003141:Communicable Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D002052:Myanmar; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D012036:Refugees; D013785:Thailand; D055815:Young Adult