Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Abstract

Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive WeilFelix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%. Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.

Rickettsial Infection in Patients with Acute Febrile Illness at a Tertiary Care Hospital in Bengaluru, India - Serological, Demographic and Clinical Profile

“…Increased outdoor activity may be the reason for this gender and age bias. Majority of the cases were seen during rainy season (68%) followed by (29%) in winter, similar observation has been made in other studies as well [5,8,11]. This seasonality may be attributed to change in climate.…”

Central Nervous System (CNS) Manifestations in Probable Case of Rickettsial Infections in Children in Central Karnataka

“…Neurological manifestations have long been recognized as complications of rickettsial infections and the word ''typhus'' itself comes from the Greek word whose meaning -hazy or smoky -is related to the mental status of affected individuals [4]. The CNS involvement in rickettsial diseases are secondary to systemic nature of disease and infective vasculitis caused by them but direct invasion is also documented [5]. Majority of patients have neurological involvement in the form of aseptic meningitis, meningoencephalitis, acute encephalitic syndrome, cerebral infarct or post-infective demyelination like Guillain Barre syndrome or acute demyelinating encephalomyelitis [6].…”

Central and peripheral nervous system involvement in a patient with scrub infection

“…Hearing loss[ 18 ] due to cochlear damage due to vasculitis or immune-mediated process and retinal vasculitis[ 19 ] leading to temporary loss of vision in children has also been reported.…”