title: Clinical Profile of Scrub Typhus in Pregnancy in Sub-Himalayan Region.
abstract: BACKGROUND
  Scrub typhus is rare in pregnancy, but it has now become an important cause of febrile illness in pregnancy in sub-Himalayan region of India. Only a few case reports have been published so far, and they show adverse maternal and fetal outcomes. No consensus has been reached till now regarding treatment.
  
  
  METHODS
  All the pregnant patients irrespective of period of gestation admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed using a detailed history of symptoms, travel, recreation, agricultural activities, treatment record prior to admission, and a detailed examination, and the treatment outcome was noted. Fever workup including cultures, CXR, CSF analysis, serology for scrub was done. IgM scrub typhus was done by kit method manufactured by InBios Intertational, Inc.
  
  
  RESULTS
  We observed in total 14 pregnant patients out of which eight were in the the second trimester and six were in the third trimester. The clinical features of the disease observed for pregnant females were the same as for nonpregnant females. There was no difference in the severity of scrub typhus between pregnant and nonpregnant women. No mortality was found in these patients. On follow-up, they had normal peripartum and postpartum periods. All were treated with azithromycin 500 mg once a day for 5 days.
  
  
  CONCLUSIONS
  Although rare, scrub typhus should be considered in differential diagnosis of fever in pregnant patients especially in scrub season. Azithromycin should be the drug of choice in pregnancy as it has no adverse effect on fetus and pregnancy outcome.
authors.affiliation: Department of Cardiology, IGMC Shimla, Shimla, India.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Medicine, IGMC Shimla, Shimla, India.
authors.forename: Surinder
authors.initials: S
authors.lastname: Thakur
authors.affiliation: Department of Medicine, IGMC Shimla, Shimla, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Bhawani
authors.affiliation: Department of Microbiology, IGMC Shimla, Shimla, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Kanga
authors.affiliation: Department of Medicine, IGMC Shimla, Shimla, India.
authors.forename: Asha
authors.initials: A
authors.lastname: Ranjan
keywords: Azithromycin; Mortality; Outcome; Pregnancy; Scrub typhus