Background Our goal was to study the demographic, clinical and laboratory profile and outcome of scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in the pediatric age group. Methods We conducted a prospective observational study in a tertiary care teaching hospital over a period of 1 year. Children in the age group of 1 month to 12 years with IgM ELISA positive for scrub typhus were included in the study. HLH was diagnosed using HLH-2004 criteria. Demographic, clinical and laboratory profile, treatment and outcome of HLH patients were noted and also compared with non-HLH scrub typhus patients. Results Among 58 children with scrub typhus infection, 18 had HLH. The mean age of patients with HLH was 35.3 ± 44.8 months and 61% were male. Anemia, thrombocytopenia and hyperferritinemia were seen in all the patients. Hypertriglyceridemia, hypofibrinogenemia and coagulopathy were noted in 78%, 56% and 44%, respectively. All the patients were treated with intravenous doxycycline for an average duration of 9.5 days. Intravenous immunoglobulin and methylprednisolone were given in 33% and 22% cases, respectively. Complications like acute respiratory distress syndrome (ARDS) (p = 0.001) and MODS (p = 0.004) were significantly high in the HLH group. Younger age (<3 years), fever > 7 days, presence of convulsion, ARDS and MODS were the clinical predictors of scrub typhus-associated HLH. Conclusion HLH in scrub typhus infected children is being increasingly recognized. Younger age, prolonged fever, presence of convulsion, ARDS and MODS should alert clinicians of the risk of HLH. Treating the primary cause usually cures the disease and immunomodulator therapy need not be routinely administered.

Objective of our study was to determine the clinical characteristics and laboratory profile of scrub typhus patients requiring pediatric intensive care admission and to find out risk factors for the severity of illness. This was a cross-sectional observational study conducted on 1-month to 12-year-old children admitted with scrub typhus in a tertiary care pediatric intensive care unit (PICU). Relevant demographic, clinical, laboratory, treatment, and outcome-related data were documented. The severity of the disease was measured in the form of multiple organ dysfunction syndrome (MODS). With further correlation, and univariate and multivariate analyses, factors associated with severe disease were identified. During the study period, out of 586 PICU admission, 62 patients (10.6%) were diagnosed with scrub typhus. The mean age was 63.85 ± 52.78 months, where infants constituted 32.3% of the total population. Fever was present in 100% of the cases. Common indications of PICU admission were: respiratory distress 42 (67.7%), altered sensorium 41 (66.1%), convulsion 37 (59.7%), and shock 31 (50%). Total number of patients with MODS was 40 (64.5%). The case fatality rate was 8%. On multivariate analysis, infant age group (p = 0.02), altered sensorium (p = 0.001), reduced urine output (p = 0.02), thrombocytopenia (p = 0.001), raised C-reactive protein (p = 0.004), hyponatremia (p = 0.005), hypoalbuminemia (p = 0.01), deranged international normalized ratio (p = 0.02), and hyperferritinemia (p = 0.02) came out to be independent factors in predictability for development of MODS. Multiorgan dysfunction is a life-threatening manifestation of scrub typus in children, which necessitates PICU admission. Infant age group, presence of altered sensorium, reduced urine output, thrombocytopenia, elevated inflammatory markers, coagulopathy, hypoalbuminemia, and hyponatremia predict risk for MODS.

Background: Scrub typhus is relatively less common among infants but found to have a mentionable association with multiple organ dysfunction and turbulent course. The aim of this study was to delineate the clinicolaboratory profile of infantile scrub typhus, complication, course of illness, and responsiveness to therapy. Subjects and Methods: This retrospective observational study was undertaken in two tertiary care pediatric teaching centers in eastern India among infants with diagnosis of scrub typhus. Clinical features, especially pattern of organ dysfunction, laboratory findings with emphasis on hyperferritinemia, and treatment schedules with responsiveness to therapy, were analyzed retrospectively. Results: A total of 272 cases of scrub typhus had been admitted during the study period. Among them, 17 kids (6.25%) were infants. All of them presented with lethargy and poor feeding as a common complaint along with seizures and respiratory distress. Seven out of 17 (41%) were identified early. Fifteen (88%) were critically ill and required pediatric intensive care unit admission, out of which 13 (76.4%) patients were put on ventilator support. Thirteen (76.4%) of them developed hyperferritinemia with multi-organ dysfunction syndrome (MODS) and required additional immunotherapy. Sixteen of them recovered completely without any sequelae. Severe complications such as acute respiratory distress syndrome and MODS were significantly high (P = 0.001 and 0.004, respectively) and hospital stay was longer (P-0.04) in infants in comparison to older children. Conclusion: We conclude that infantile scrub typhus, though not very common, should be considered an important differential in infants presenting with an acute febrile illness with hyperferritinemia and MODS. Infants with scrub typhus can have a more stormy disease course compared to their older counterparts.