Is scrub typhus during pregnancy risky?

Question

Hello doctor,

My wife is 36 years old, and she is a documentary filmmaker. She was filming tribal rituals and developed a severe fever and headache five days ago, along with these black scabs around her ankles. A local clinic confirmed scrub typhus, but her case is complicated by pregnancy (24 weeks). She is now showing signs of disseminated intravascular coagulation, bleeding from multiple sites, and severe bruising. She started on Azithromycin since she is allergic to Doxycycline but is developing worsening respiratory failure. Her fetal monitoring shows recurrent decelerations. The hospital has limited maternal ICU facilities. Two village children she filmed died from similar complications. Should we risk an aeronautical transfer to Delhi? What is the mortality risk with pregnancy? I also noticed she is developing visual disturbances and confusion; could this be cerebral involvement?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your wife’s condition is extremely critical, and it appears to be a severe form of scrub typhus during pregnancy, complicated by disseminated intravascular coagulation (DIC), respiratory failure, and possible cerebral involvement. Immediate transfer to a tertiary care hospital equipped with an ICU (intensive care unit) and advanced maternal-fetal medicine services is essential to provide the care she needs.

Immediate priorities are required for the following listed below:

Respiratory failure: She may require invasive ventilation or high-flow oxygen, especially if ARDS (acute respiratory distress syndrome) develops. Close respiratory monitoring is critical.
Cerebral symptoms: Confusion and visual disturbances might indicate encephalitis, a serious manifestation of scrub typhus. Urgent brain imaging such as CT (computed tomography) or MRI (magnetic resonance imaging) and, if feasible, a lumbar puncture can help evaluate this further.
Fetal monitoring: Recurrent fetal heart rate decelerations suggest distress, but the primary focus must remain on stabilizing maternal health first.

Management steps:

Antibiotic treatment: Azithromycin is the correct choice given her allergy to Doxycycline and her pregnancy. If her condition does not improve, Rifampicin may be considered as an adjunct, based on expert consultation.
DIC (disseminated intravascular coagulation) management: Supportive care with fresh frozen plasma (FFP) or cryoprecipitate to manage coagulopathy. Platelet transfusions may be needed if there is significant bleeding. Maintain a careful balance of IV (intravenous) fluids to avoid worsening respiratory distress.
Fetal considerations: Maternal survival is the top priority. Emergency delivery (if feasible) should only be considered if her condition deteriorates further or fetal demise is confirmed.
Neurological care: Monitor neurological symptoms closely and consider corticosteroids for inflammation under expert guidance.

5. Aeromedical transfer: Given her rapidly worsening condition and the limitations of your current facility, a transfer to a tertiary care hospital or another advanced center is urgently needed. Ensure her respiratory status is stabilized for the journey (with ventilatory support if needed). Minimize travel time and coordinate with an aeromedical team equipped to handle critically ill patients. Notify the receiving hospital in advance to ensure they are prepared with ICU and neonatal care facilities.

Prognosis and risks:

This is an incredibly challenging situation. Severe scrub typhus with complications like ARDS, encephalitis, and DIC has a high maternal mortality risk (30 to 50 percent without advanced care). Fetal risks are also significant, but maternal stabilization must take priority for the best possible outcome.

Urgent recommendation

Please arrange for her immediate transfer to a well-equipped tertiary care facility. The sooner she receives multidisciplinary care, the better her chances of recovery. Notify the hospital in advance so they can prepare for her arrival.

I understand how overwhelming this must feel, but acting quickly can make all the difference.

I hope this has helped you.

Please feel free to reach me again, in case of further queries.

Thank you.