Massive consolidation: a rare manifestation of paediatric Scrub typhus

Manickam, Kumar; Sunderkumar, Satheeshkumar; Chinnaraj, Sridharan; Sivathanu, Shobhana

doi:10.1136/bcr-2013-200687

Cited by 8 publications

(10 citation statements)

References 14 publications

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“…Among nine case reports (Table 1B), one evaluated scrub typhus [83] and another a coinfection of dengue and typhoid in a child [80]. Two studies evaluated mixed infections in adults [77, 85].…”

Section: Resultsmentioning

confidence: 99%

Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review

Bhaskaran

Chadha²,

Sarin³

et al. 2019

BMC Infect Dis

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BackgroundAcute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics. The lack of appropriate diagnostics for the evaluation of AFI leads to increased morbidity and mortality in resource-limited settings, specifically low-income countries like India. The review aimed to identify the number, type and quality of diagnostics used for AFI evaluation during passive case detection at health care centres in South India.MethodsA scoping review of peer-reviewed English language original research articles published between 1946-July 2018 from four databases was undertaken to assess the type and number of diagnostics used in AFI evaluation in South India. Results were stratified according to types of pathogen-specific tests used in AFI management.ResultsThe review included a total of 40 studies, all conducted in tertiary care centres (80% in private settings). The studies demonstrated the use of 5–22 tests per patient for the evaluation of AFI. Among 25 studies evaluating possible causes of AFI, 96% tested for malaria followed by 80% for dengue, 72% for scrub typhus, 68% for typhoid and 60% for leptospirosis identifying these as commonly suspected causes of AFI. 54% studies diagnosed malaria with smear microscopy while others diagnosed dengue, scrub typhus, typhoid and leptospirosis using antibody or antigen detection assays. 39% studies used the Weil-Felix test (WFT) for scrub typhus diagnosis and 82% studies used the Widal test for diagnosing typhoid.ConclusionsThe review demonstrated the use of five or more pathogen-specific tests in evaluating AFI as well as described the widespread use of suboptimal tests like the WFT and Widal in fever evaluation. It identified the need for the development of better-quality tests for aetiological diagnosis and improved standardised testing guidelines for AFI.

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Section: Resultsmentioning

confidence: 99%

Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review

Bhaskaran

Chadha²,

Sarin³

et al. 2019

BMC Infect Dis

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“…Airspace consolidation is relatively uncommon and generally appears in the lower zone of both lungs. Our patient had a massive airspace consolidation involving the left upper and lingular lobes which is an unusual pulmonary manifestation of scrub typhus and has been reported once in literature [15]. Characteristic high-resolution computed tomography (HRCT) features of scrub typhus include ground-glass opacity predominantly in the lower zones, bronchial wall thickening, centrilobular nodules, and interlobular septal thickening [16].…”

Section: Discussionmentioning

confidence: 75%

An Unusual Clinical Presentation of Scrub Typhus

Sethuraman

Balasubramanian

2019

Cureus

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Scrub typhus is still underdiagnosed despite a resurgence in incidence as the clinical presentation is often atypical leading to low index of suspicion among clinicians. We report a case of a young girl presenting as lobar pneumonia and diagnosed as scrub typhus. Despite such a classical picture of community-acquired pneumonia on clinical presentation and radiological findings the patient was found to have scrub typhus serologically thereby posing a diagnostic dilemma. Upon serological confirmation, doxycycline therapy was initiated followed by a rapid and complete resolution of pneumonia, both clinically and radiographically. This case report highlights the importance of recognizing an uncommon clinical presentation of this common tropical disease and its prompt diagnosis and treatment.

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“…Consolidation of upper and lingular lobe, as in the case reported here, has not been documented previously in the literature. 19 In this child, it was the shallow ulcer in the groin that made us suspect scrub typhus even in the absence of a classic eschar.…”

Section: Discussionmentioning

confidence: 90%

“…A total of 31 cases were enrolled in the study. Boys predominated (n ¼ 21, 68%); most cases were in school-going children aged 5 to 12 years (n ¼ 25, 81%) and from urban areas (n ¼ 23, 74%) The predominant pattern of fever was intermittent (n ¼ 30, 97%) and cases had a mean duration of fever at presentation of 11 days (range, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. In most cases, the fever was moderate grade (n ¼ 17, 55%).…”

Section: Resultsmentioning

confidence: 99%

Clinical Profile, Outcome, and Atypical Presentations of Scrub Typhus: Experience from a Tertiary Care Center in South India

Sivathanu

Jayaraman

Parthasarathy

et al. 2017

J Pediatr Infect Dis

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Background?The aim of this study was to describe the clinical profile and atypical presentations of scrub typhus in children aged younger than 12 years admitted to a tertiary care center in south India. Materials and Methods?A retrospective chart review of children diagnosed with scrub typhus from January 2014 to January 2015 was performed; the clinical features (including atypical presentations), laboratory parameters, and response to treatment were analyzed. Results?The majority of the cases was from urban areas and presented with gastrointestinal manifestations (25/31). Eschar was noted in 23 children (74%) and was typically found above the level of the umbilicus. All cases showed a rapid resolution with doxycycline. Atypical presentations included massive lung consolidation, epididymo-orchitis, secondary hemophagocytic lymphohistiocytosis, and ?Kawasaki-like? disease. Infants in the group presented with low to moderate grade fever, significant hepatosplenomegaly, high C-reactive protein, and leukocytosis with lymphocytic preponderance. We propose that this tetrad of features, even in the absence of an eschar, should point to a possible diagnosis of scrub typhus in infants. Conclusion?Changes in typical presentation of pediatric scrub typhus present a continuing diagnostic challenge.

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Massive consolidation: a rare manifestation of paediatric Scrub typhus

Cited by 8 publications

References 14 publications

Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review

Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review

An Unusual Clinical Presentation of Scrub Typhus

Clinical Profile, Outcome, and Atypical Presentations of Scrub Typhus: Experience from a Tertiary Care Center in South India

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