Scrub Typhus in Pregnancy: A Retrospective Observational Study From Primary Hospital of Southwest China

Scrub typhus is an acute zoonotic disease caused by Orientia tsutsugamushi. There are limited reports on scrub typhus in pregnancy, and the misdiagnosis rate is relatively high, potentially leading to adverse maternal and fetal outcomes.

This retrospective observational study analyzed 19 pregnant patients with scrub typhus admitted to the People's Hospital of Ximeng Wa Autonomous County, Southwest China, from August 2023 to November 2025. Epidemiological, clinical, test, treatment, and outcome data were collected and descriptively analyzed.

All patients were farmers, with 73.68% reporting a history of outdoor activities. Common symptoms included fever (100%), myalgia (78.94%), headache (57.89%), and eschar (94.74%). Laboratory findings revealed elevated transaminases (ALT or AST 94.74%) and decreased eosinophil percentages (89.47%). Initial misdiagnosis occurred in 10.53% (upper respiratory infection). Among the 18 patients treated with azithromycin, fever resolution occurred within 1 to 5 days. No maternal deaths occurred. However, adverse fetal outcomes included spontaneous miscarriage (n = 1), embryonic arrest (n = 1), and embryo demise (n = 3). Among 19 cases, 14 resulted in live births; 2 premature infants required pediatric care, and all live-born newborns showed normal development at six-month follow-up.

Scrub typhus in pregnancy poses serious maternal-fetal risks. Early clinical recognition and prompt azithromycin therapy are crucial for improving maternal and perinatal outcomes, especially in resource-limited settings.