Spotted Fever Rickettsial Infection in Pregnancy Causing Acute Hepatitis, Fatal Postpartum Hemorrhage and Possible Vertical Transmission
R. M. C. J. Ratnayake
Department of Obstetrics and Gynecology,Faculty of Medicine,University of Peradeniya, Sri Lanka.
W. M. M. P. B. Wanasinghe *
Teaching Hospital Peradeniya, 20400, Sri Lanka.
P. Dissanayake
Department of Pediatrics Faculty of Medicine,University of Peradeniya, Sri Lanka.
S. A. M. Kularatne
Department of Medicine, Faculty of Medicine University of Peradeniya, Peradeniya, Sri Lanka.
M. V. G. Pinto
Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Peradeniya, Peradeniya, Central province, Sri Lanka.
T. M. K. Jayasinghearachchi
Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Peradeniya, Peradeniya, Central province, Sri Lanka.
R. P. V. J. Rajapakse
Department of Veterinary Pathobiology, Faculty of veterinary Medicine and Animal Science, University of Peradeniya, Sri lanka.
*Author to whom correspondence should be addressed.
Abstract
We present a rare case of a 31-year-old pregnant mother in 37 weeks of gestation who presented with a 3-day history of vomiting, epigastric pain, and icterus, subsequently diagnosed as a rickettsial disease in pregnancy (with positive IgG titer for SFG) complicated with hepatitis, coagulopathy, pulmonary hemorrhage, and post-partum hemorrhage, who expired despite intensive care management. The newborn baby also had high IgG titer for SFG suggesting a vertical transmission of the disease and recovered following treatment with chloramphenicol. The SFG rickettsial infection can cause diverse clinical manifestations in pregnancy including acute hepatitis and coagulopathy. Therefore, the possibility of SFG rickettsial infection needs to be considered in diagnostic workup in obscure clinical presentations. We postulate possible vertical transmission of SFG to newborns which needs further confirmation.
Keywords: Rickettsial infection, Pregnancy, vertical transmission