Scrub Typhus in Third Trimester of Pregnancy: a Rare Cause of Maternal Near Miss

Scrub typhus in pregnancy may present with a varying clinical spectrum ranging from mild febrile illness to multi-organ dysfunction. Severe forms of untreated disease may result in maternal and/or fetal death. We present the case of a primigravida in her third trimester of pregnancy with scrub typhus who faced “maternal near miss” and fetal demise. A 25-year-old primigravida at 36 weeks of gestation was referred to us with fever, headache, and malaise for 15 days and progressive dyspnea for 2 days. She was being treated with antipyretics and non-specific antibiotics before referral. She had tachycardia, hypotension, tachypnoea, orthopnea, oxygen saturation of 90% on room air, and generalized anasarca. Investigations revealed thrombocytopenia, deranged renal function tests, and increased procalcitonin. Azithromycin and ceftriaxone were started empirically. ELISA for Scrub typhus was positive. Subsequently, an eschar was found below the left breast. Her condition improved with resuscitation, supportive therapy, and definitive treatment. The patient had spontaneous labor within 24 h of admission resulting in vaginal delivery. She had intrapartum stillbirth. After delivery, she again developed respiratory distress requiring intubation. The chest X-ray showed a deteriorating picture with consolidation in the right upper lung and bilateral reticulo-nodular opacities. Antibiotics were switched to meropenem and doxycycline 100 mg twice a day. The fever subsided after day 4 postpartum and she was gradually weaned off from the ventilator. It is important to consider scrub typhus as a differential early in the course of fever especially in tropical countries. Delay in diagnosis and hence, treatment can result in catastrophic outcomes.