Document Detail


Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border.
MedLine Citation:
PMID:  21103369     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
METHODOLOGY: 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.
PRINCIPAL FINDINGS: 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).
CONCLUSION/SIGNIFICANCE: 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:
Rose McGready; Elizabeth A Ashley; Vanaporn Wuthiekanun; Saw Oo Tan; Mupawjay Pimanpanarak; Samuel Jacher Viladpai-Nguen; Wilarat Jesadapanpong; Stuart D Blacksell; Sharon J Peacock; Daniel H Paris; Nicholas P Day; Pratap Singhasivanon; Nicholas J White; François Nosten
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-16
Journal Detail:
Title:  PLoS neglected tropical diseases     Volume:  4     ISSN:  1935-2735     ISO Abbreviation:  PLoS Negl Trop Dis     Publication Date:  2010  
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-04-12     Revised Date:  2014-08-12    
Medline Journal Info:
Nlm Unique ID:  101291488     Medline TA:  PLoS Negl Trop Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e888     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Animals
Arthropod Vectors* / microbiology,  parasitology,  virology
Cohort Studies
Communicable Diseases / drug therapy,  epidemiology,  transmission*
Female
Fever / drug therapy,  epidemiology,  etiology*
Humans
Myanmar
Pregnancy
Pregnancy Complications, Infectious / drug therapy,  epidemiology,  etiology*
Pregnancy Outcome
Refugees*
Thailand
Young Adult
Grant Support
ID/Acronym/Agency:
093956//Wellcome Trust; //Wellcome Trust
Comments/Corrections

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