Foetal outcome of Leptospira and Rickettsial infections during pregnancy: A Systematic Review

Abstract

Background – Leptospirosis and Rickettsial infections including scrub typhus are murine typhus are bacterial zoonosis prevalent in different geographical locations. This systematic review aims to identify foetal outcome in pregnant woman diagnosed with Rickettsial infection including scrub typhus and leptospirosis along with its associated factors. Methods - A comprehensive search was done in MEDLINE/PubMed, Scopus, CENTRAL (Cochrane), Web of Science, PsycInfo, Academic Search Premier, CINAHL, and Embase using a defined search term. The selection criteria were studies having pregnant women with diagnosed leptospirosis and Rickettsial infections including scrub typhus. The studies were excluded based on - diagnosis not clear, animal study, in vitro study, no pregnant population, co-infection, other infection except those concerned, seroprevalence without any foetal outcome. Studies in language other than English were also excluded. The initial screening of titles and abstracts was conducted by two independent reviewers using the Rayyan Web interface. Discrepancies were resolved through discussion or consultation with a third reviewer. Full-text review was carried out by the two reviewers, with disagreements resolved similarly. Data extraction was performed in Microsoft Excel, aided by Zotero for reference management. The assessment of study quality utilized The Joanna Briggs Institute Critical Appraisal tools. Data synthesis and analysis included a narrative synthesis of findings. Main results – A total of 54 studies were included in the systematic review for analysis. Among the 54 studies included in the systematic review, 22 had data on only scrub typhus, 14 had data on only Rickettsial infection, 16 had data on leptospirosis and 2 studies had data on all three infections. A total of 176 cases of scrub typhus were included with foetal loss in 53 (30.11%) and neonatal death in 3 (1.7%). Among the 38 cases of Rickettsial infection, 4 (10.5%) had foetal loss. Out of the total 63 cases of leptospirosis 13 (20.6%) had foetal loss. There were 6 maternal deaths due to scrub typhus and one maternal death due to Rocky Mountain spotted fever. Conclusion – Leptospirosis and Rickettsial infections including scrub typhus are important causes of loss of pregnancy. Hence diagnosis and appropriate management of these cases in pregnancy is essential.