Complication profile of scrub typhus and its association with total leucocyte count

Gupta, Prahlad; Gurjar, Umesh; Sharma, Bhawna; Gupta, Monica

doi:10.18203/2349-3291.ijcp20164585

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…The lowest leucocyte count reported was 2750 cells/mm 3 and the highest WBC count was 28,910 with a mean WBC count of 12,316. Leucopenia associated with scrub typhus was found out as a risk factor for development of complicated scrub typhus as reported by Gupta et al 19 After completion of treatment, leukocytosis persisted in 5 children in the azithromycin group and 8 children in the doxycycline group, whereas leucopenia resolved in all children in both the groups. Such results on resolution of laboratory parameters following treatment have not been reported earlier.…”

Section: Discussionsupporting

confidence: 58%

Oral Azithromycin Versus Doxycycline in the Treatment of Children With Uncomplicated Scrub Typhus

Kabir¹,

Jelonnek²,

Satapathy³

et al. 2021

Pediatric Infectious Disease Journal

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Objectives: To compare the efficacy of azithromycin versus doxycycline in treatment of children with uncomplicated scrub typhus in terms of percentage of children who attained remission of fever after 72 hours of administration of first dose of the study drug, mean time taken to attain fever defervescence, normalization of laboratory parameters, resolution of hepatosplenomegaly and lymphadenopathy. Design: Interventional, open-labeled randomized controlled trial.

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Section: Discussionsupporting

confidence: 58%

Oral Azithromycin Versus Doxycycline in the Treatment of Children With Uncomplicated Scrub Typhus

Kabir¹,

Jelonnek²,

Satapathy³

et al. 2021

Pediatric Infectious Disease Journal

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“…The median total blood leucocyte count (15 000) and blood lymphocyte count were significantly higher whereas the platelet count was significantly lower in scrub typhus. A higher total leucocyte count in scrub typhus is against the general belief that scrub typhus is associated with leucopenia, as reported from India 20,26 ; however, studies have reported leucocytosis similar to that in the present study. 17,25,27 Thrombocytopenia ranging from 44.7% to 92.3% was frequently described by other authors as well.…”

Section: Discussioncontrasting

confidence: 57%

Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India

et al. 2020

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Objectives: To evaluate the proportion of scrub typhus meningoencephalitis among children with acute encephalitis syndrome and to outline its differentiating features. To develop a prediction rule for scrub typhus meningoencephalitis. Methods: A prospective cohort study was conducted at a tertiary care public hospital in Northern India. Consecutive patients of acute encephalitis syndrome who met our inclusion criteria were enrolled over 2 years. Standardized workup including serum IgM against Orientia tsutsugamushi was performed. Clinical and laboratory features were compared between IgM-positive and IgM-negative patients. The area under the receiver operating characteristic curve of the score derived from “independent predictors” was measured. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated at different cut-offs of the score. Results: Scrub typhus IgM enzyme-linked immunosorbent assay was positive in 66/352 patients (18.8%). Longer duration of fever and prodromal stage along with eschar, hepatomegaly, lymphadenopathy, and pneumonia were significantly more prevalent in scrub typhus meningoencephalitis. However, petechiae were frequent in non–scrub typhus patients. Leucocytosis, lymphocytosis, thrombocytopenia, hypoalbuminemia, and elevated levels of serum bilirubin, serum transaminases, and cerebrospinal fluid protein were associated with scrub typhus meningoencephalitis. Logistic regression revealed fever for >8 days, pneumonia, absence of petechiae, cerebrospinal fluid protein >1000 mg/L, and serum glutamic oxaloacetic transaminase >100 IU/L as independent “predictors” of scrub typhus meningoencephalitis. The area under the receiver operating characteristic curve (95% confidence interval) of the prediction score was 0.832 (0.78-0.89). Score at cutoff ≥1 had 91% sensitivity, 96.1% negative predictive value, and at cutoff ≥4 had 99.7% specificity, 88.9% positive predictive value, 83.1% negative predictive value, 40.3 positive likelihood ratio, 0.88 negative likelihood ratio for identifying scrub typhus meningoencephalitis. Conclusion: Prediction score may help physicians in peripheral areas to identify and treat scrub typhus meningoencephalitis, an emerging cause of acute encephalitis syndrome in India.

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“…All the finding are at per with the reports of other researchers, except reduced urine volume and arthralgia, which found lesser in this study than other authors. 16,25,[29][30][31] An Eschar, which is a pathognomonic sign of scrub typhus infection found in 44.56% cases in this study. Similar findings reported by many previous studies, and much higher occurrence of eschar reported by some other researchers.…”

Section: Discussionsupporting

confidence: 47%

“…Similar findings reported by many previous studies, and much higher occurrence of eschar reported by some other researchers. 6,16,25,29,[30][31][32][33] Hepatomegaly (89.73%), lymphadenopathy (78.23%), pallor (74.33%) and splenomegaly (67.55%) were the common findings in this study. Other studies reported varied occurrence of hepatomegaly (26%-98%) and splenomegaly (17%-88%).…”

Section: Discussionmentioning

confidence: 82%

A study on clinical spectrum, complications and outcome of scrub typhus infection in children admitted in pediatric department of a tertiary care hospital in West Bengal, India

Kabiraj

Saha

Maiti

et al. 2022

Int J Contemp Pediatr

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Background: Scrub typhus is an important emerging etiology of febrile illnesses. Most of the studies of scrub typhus in literature have been carried out in adult population. The objective of the study is to obtain data on clinical spectrum, complications and outcome of scrub typhus infection in pediatric patients.Methods: This is a descriptive observational study, that includes 487 scrub typhus IgM ELISA positive children, conducted over a period of 36 months at Bankura Sammilani medical college & hospital, Bankura- a tertiary care government hospital in southern part of West Bengal. Data were collected in predesigned case record proforma and then analysed.Results: Highest number of cases were found among 2 to 6 years age group with male predominance, mostly from rural area & during the monsoon season. Fever, rash, headache, vomiting, cough-cold, myalgia, diarrhoea & body swelling were main presenting complaints. Hepatomegaly, lymphadenopathy, splenomegaly, eschar, pallor, edema were main examination findings. Anaemia, thrombocytopenia, leucocytosis, transaminitis were the important laboratory findings. Important complications were- hepatitis, bronchopneumonia, meningoencephalitis, pleural effusion, shock, myocarditis, acute kidney injury, respiratory failure, ARDS, MODS etc. Both azithromycin & doxycycline were effective for treatment of scrub typhus infection. Overall mortality was noted in 7.80%.Conclusions: Scrub typhus is an important re-emerging etiology of febrile illnesses in children. So, it should be kept in differentials of acute undifferentiated febrile illness in children. If diagnosed early, it is easy to treat with azithromycin and/or doxycycline and complications and mortality can be minimized significantly.

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Complication profile of scrub typhus and its association with total leucocyte count

Cited by 5 publications

References 6 publications

Oral Azithromycin Versus Doxycycline in the Treatment of Children With Uncomplicated Scrub Typhus

Oral Azithromycin Versus Doxycycline in the Treatment of Children With Uncomplicated Scrub Typhus

Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India

A study on clinical spectrum, complications and outcome of scrub typhus infection in children admitted in pediatric department of a tertiary care hospital in West Bengal, India

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