Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand.
PLoS Negl Trop Dis. 2010 Nov 16;4(11):e888. doi: 10.1371/journal.pntd.0000888.
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.
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.
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.
孕期发热对母婴均有危险。20 世纪 80 年代，疟疾是泰国-缅甸边境难民营中孕妇死亡的主要原因。青蒿素联合疗法显著降低了疟疾在人群中的发病率。孕期发热的其他病因尚未得到充分记录。
参加产前检查的孕妇每周例行筛查疟疾，如果发热，将接受全面的临床和实验室筛查。发热孕妇将被收入院治疗，并在分娩前每周进行随访。在第 21 天采集恢复期血清。记录分娩结局。
2004 年 1 月 7 日至 2006 年 5 月 17 日期间，在参加产前门诊的 8117 名孕妇中，5.0%（409/8117）出现发热（n=438）。主要病因是疟疾，占 55.5%（227/409）。对 203 名（409 名中 49.6%）发热孕妇进行了详细的发热病因调查和随访。节肢动物传播疾病（疟疾、立克次体感染和登革热）和人畜共患病（钩端螺旋体病）占所有发热性疾病的近一半，占 47.3%（96/203）。在 3.9%（8/203）的妇女中观察到混合感染，主要是疟疾和立克次体。肾盂肾炎占 19.7%（40/203），也是发热的常见原因。通过显微镜检查和/或临床发现排除疟疾、肾盂肾炎和急性呼吸道感染后，三分之一的剩余发热感染将由立克次体或钩端螺旋体引起。丛林斑疹伤寒和鼠型斑疹伤寒与死胎和低出生体重等不良妊娠结局相关。有 1 名妇女死亡（实验室检查均为阴性）。
结论/意义：在泰国-缅甸边境，疟疾仍然是孕妇发热的主要原因。丛林斑疹伤寒和鼠型斑疹伤寒也是发热的重要原因，与不良妊娠结局相关。在泰国-缅甸边境，没有疟疾、肾盂肾炎或呼吸道感染的发热孕妇应使用阿奇霉素治疗，该药对斑疹伤寒和钩端螺旋体病有效。
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