Typhoid & pregnancy
Typhoid during pregnancy presents with many clinical dilemmas.
1) Patient already treated for typhoid fever is subsequently found to have pregnancy. Here the questions that obstetrician has to answer to him and to the patient are about safety of antibiotics and drugs used to treat this febrile disease.
2) Was it, in fact typhoid or some other illness?
3) Is typhoid fever teratogenic, what are the other effects of typhoid on pregnancy?
4) What are the effects of typhoid vaccination on pregnancy? Is it safe during pregnancy?
Diagnosis of typhoid during pregnancy- Any febrile disorder lasting for more than few days in spite of use of antibiotics and antimalarials (traditional practice) should be suspected to have typhoid and investigated accordingly. Typhoid has varied clinical presentation but fever is the most consistent symptom (occurring in 70% cases) and no single laboratory finding is consistent. Thus physicians practicing in typhoid prone regions of the world should bear in mind that typhoid has many unusual clinical features.The antibiotics commonly used for treating suspected case of typhoid are-Chloramphenicol, Trimethoprim, Ciprofloxacin, Cefotaxime, Azithromycin, Ceftriaxone, Cefoperazone, Ofloxacin, Levofloxacin. None of these is a clearly known teratogen. All belong to B and C categories of ‘ABCD and X’ categorization of drugs and medications given by FDA.
Antipyretics in common use are also not proven teratogens, similarly corticosteroids used in complicated typhoid fever belong to category c.
Cases where typhoid could not be confirmed by laboratory diagnosis and where clinical picture was atypical, teratogenic infections should be ruled out by appropriate serology. But amongst the teratogenic infections; Varicella (Chickenpox), Parvovirus B19, Rubella, Toxoplasmosis, Syphilis, Cytomegalovirus; none is a cause of high grade fever as in typhoid.
Typhoid infection by itself is not teratogenic. Its effects on pregnancy are because of severe pyrexia. All high grade fevers are uterine stimulant and fetotoxic. These effects can precipitate preterm labour and intra-uterine death.Often pregnant women request for typhoid immunization for reasons like prospective visit to typhoid endemic region, international travel or for protection during epidemic. Two types of vaccines are available oral and intramuscular. Oral vaccine is contraindicated during pregnancy because it is a live virus, presenting theoretic risks of transmission to the fetus. Intramuscular vaccine is recommended for these women by Association of Professors of Obstetrics and Gynecology.