Patient's Query
Hello doctor,
My pregnant wife aged 25 got scrub typhus after working in our sugarcane field last week. Her fever is very high (104.5°Farenheit) and she has this black mark (eschar) behind her neck that keeps growing. We noticed these red spots all over her body and she was so confused. Our local doctor started Doxycycline but was worried about whether it was safe during pregnancy. Her blood pressure is very low (82/48 mm/Hg) and her heart is beating very fast (135 bpm). The baby's movements have reduced since yesterday. The nearest big hospital is 4 hours away. Should we risk the journey?
Kindly suggest.
Hello,
Welcome to iCliniq.com.
I understand your concern.
The combination of high fever, eschar (a sign of scrub typhus), low blood pressure, rapid heart rate, confusion, and reduced fetal movement requires urgent medical attention. High fever (104.5°Farenheit) and confusion can indicate severe systemic involvement. Scrub typhus can cause multi-organ damage, especially if not treated promptly. In pregnancy, the infection can increase risks for both the mother and the baby. The reduced fetal movements are a significant concern. Infections and severe illness in pregnancy can cause fetal distress, and monitoring the baby’s well-being is crucial. Her low blood pressure (82/48 mm/Hg) and tachycardia (heart rate of 135 bpm) indicate possible shock, dehydration, or other complications from scrub typhus. These are critical symptoms that need to be stabilized quickly.
Doxycycline (antibiotic) is generally not recommended during pregnancy, particularly in the first and second trimesters, as it can cause fetal harm (for example, teeth discoloration and bone growth issues). The risk-to-benefit ratio needs to be carefully considered. Azithromycin is typically the preferred antibiotic for pregnant women with scrub typhus. Given that the nearest hospital is four hours away, you are at risk of her condition worsening during the journey. Immediate intervention is needed, especially for stabilization and monitoring of both her and the baby. If her condition worsens further, transport could become even more difficult or risky.
Go to the hospital immediately, even if it is four hours away. The risks of delaying care outweigh the risks of the journey. If possible, arrange for a well-equipped ambulance with medical support, as her condition is serious, and close monitoring will be needed during transport. Call ahead to the hospital to notify them of her condition so they can prepare for her arrival and ensure they have the appropriate resources to manage scrub typhus in pregnancy. In the meantime, try to keep her hydrated (if she can tolerate fluids), avoid any further physical exertion, and keep her as comfortable as possible. Her condition is time-sensitive, and receiving the right treatment and monitoring at a higher-level medical facility is crucial for both her and the baby's health.
I hope this helps.
Let me know if you have any other concerns.
Thank you.
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Answered byDr. Saumya Mittal
Medically reviewed byiCliniq medical review team
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