Culture-confirmed typhoid fever and pregnancy

Background: The relationship between pregnancy and typhoid fever is not well defined. The objective of this study was twofold: to assess the effect of the pregnant and postpartum host on typhoid disease expression, and to explore the relationship between typhoid fever and pregnancy outcome. Methods: Over an 11-year period, all 181 adult women with blood culture-confirmed typhoid fever admitted to a university hospital in Karachi, Pakistan were studied; those with pregnancy-related disease were compared to the non-pregnant women. The relationship between typhoid fever and pregnancy outcome was evaluated by comparing 80 pregnant women with typhoid, with 194 randomly selected pregnant women without typhoid who were matched for age and study year. Results: In adult females with bacteremic typhoid disease, a significant proportion was pregnancy-related (47%). These women were less likely to have other co-morbid illnesses (2% vs. 27%, p < 0.001) and were almost exclusively treated with ampicillin/amoxicillin or third-generation cephalosporins, while the non-pregnant women with typhoid fever preferentially received quinolones. The mean duration of antimicrobial therapy was similar in both groups (14 days) but the nonpregnant group defervesced earlier (4.2 days vs. 5.6 days, p = 0.011). Complications of typhoid fever were significantly more likely in the non-pregnant group (23% vs. 8%, p = 0.005) and primarily involved lower gastrointestinal bleeding. On comparing the pregnant women with typhoid with randomly selected age-matched pregnant women without typhoid, there were no apparent effects of typhoid fever on pregnancy outcome as measured by gestational age at delivery, pregnancy complications, modes of delivery, neonate gender, birth weight, or birth Apgar scores. Conclusions: White pregnancy is a risk factor for and effects typhoid disease expression, typhoid fever does not appear to affect pregnancy outcome. (C) 2006 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.