ArticlePLoS neglected tropical diseases2014
Pregnancy outcome in relation to treatment of murine typhus and scrub typhus infection: a fever cohort and a case series analysis.
Article in PLoS neglected tropical diseases, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 5 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
42 citing papers in PubMed, 5 syntheses or guidelines pooled it, 59 citations in OpenAlex.
- Louse-borne relapsing fever-A systematic review and analysis of the literature: Part 2-Mortality, Jarisch-Herxheimer reaction, impact on pregnancy.PLoS neglected tropical diseases · 2021Pooled it
- Methodology of assessment and reporting of safety in anti-malarial treatment efficacy studies of uncomplicated falciparum malaria in pregnancy: a systematic literature review.Malaria journal · 2017Pooled it
- Estimating the burden of scrub typhus: A systematic review.PLoS neglected tropical diseases · 2017Pooled it
- Revisiting doxycycline in pregnancy and early childhood--time to rebuild its reputation?Expert opinion on drug safety · 2016Pooled it
- A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi).PLoS neglected tropical diseases · 2015Pooled it
- A Prospective, Open-label, Randomized Trial of Doxycycline Versus Azithromycin for the Treatment of Uncomplicated Murine Typhus.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Trial
- Murine Typhus Mimicking Preeclampsia with Severe Features.AJP reports · 2026Article
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Reduction of stillbirth rate in refugee and migrant populations living on the Thailand Myanmar border: A retrospective study 1986-2023.PLOS global public health · 2026Article
- Cohort Profile: the SMRU Refugee and Migrant Pregnancy Study in Western Thailand and Eastern Myanmar.Wellcome open research · 2026Article
- Incidence of Scrub Typhus in Rural South India.The New England journal of medicine · 2025Observational
- Scrub typhus in pregnancy: A 10-year multicenter study in resource-limited settings in China.PLoS neglected tropical diseases · 2025Article
- Scrub typhus in pregnancy: A report of two cases.Obstetric medicine · 2024Article
- Scrub typhus in pregnancy - A threat to maternal and fetal outcome.Journal of family medicine and primary care · 2024Article
- Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae.Infectious disease reports · 2023Review
- Epidemic retinitis during pregnancy.Indian journal of ophthalmology · 2023Observational
- Molecular Detection of Candidatus Orientia chuto in Wildlife, Saudi Arabia.Emerging infectious diseases · 2023Article
- Congenital scrub typhus: a case report and literature review.Frontiers in pediatrics · 2023Article
- Doxycycline use and adverse pregnancy or neonatal outcomes: A descriptive study using the United States Food and Drug Administration Adverse Event Reporting System database.Health science reports · 2022Article
- Genetic typing of isolates of Rickettsia typhi.PLoS neglected tropical diseases · 2022Article
Corrections and comments
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Authors and funding
16 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundThere is a paucity of published reports on pregnancy outcome following scrub and murine typhus despite these infections being leading causes of undifferentiated fever in Asia. This study aimed to relate pregnancy outcome with treatment of typhus. METHODOLOGY/PRINCIPAL
findingsData were analyzed from: i) pregnant women with a diagnosis of scrub and/or murine typhus from a fever cohort studies; ii) case series of published studies in PubMed using the search terms "scrub typhus" (ST), "murine typhus" (MT), "Orientia tsutsugamushi", "Rickettsia tsutsugamushi", "Rickettsia typhi", "rickettsiae", "typhus", or "rickettsiosis"; and "pregnancy", until February 2014 and iii) an unpublished case series. Fever clearance time (FCT) and pregnancy outcome (miscarriage and delivery) were compared to treatment. Poor neonatal outcome was a composite measure for pregnancies sustained to 28 weeks or more of gestation ending in stillbirth, preterm birth, or delivery of a growth restricted or low birth weight newborn.
resultsThere were 26 women in the fever cohort. MT and ST were clinically indistinguishable apart from two ST patients with eschars. FCTs (median [range] hours) were 25 [16-42] for azithromycin (n=5), 34 [20-53] for antimalarials (n=5) and 92 [6-260] for other antibiotics/supportive therapy (n=16). There were 36.4% (8/22) with a poor neonatal outcome. In 18 years, 97 pregnancies were collated, 82 with known outcomes, including two maternal deaths. Proportions of miscarriage 17.3% (14/81) and poor neonatal outcomes 41.8% (28/67) were high, increasing with longer FCTs (p=0.050, linear trend). Use of azithromycin was not significantly associated with improved neonatal outcomes (p=0.610).
conclusionThe published ST and MT world literature amounts to less than 100 pregnancies due to under recognition and under diagnosis. Evidence supporting the most commonly used treatment, azithromycin, is weak. Collaborative, prospective clinical trials in pregnant women are urgently required to reduce the burden of adverse maternal and newborn outcomes and to determine the safety and efficacy of antimicrobial treatment.
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