Scrub typhus in children at a tertiary hospital in southern India: Clinical profile and complications

Abstract

High incidences of myocarditis and acute kidney injury were observed, which indicates that the children were treated at a late stage of the disease. Clinicians should be cognizant that myocarditis and acute kidney injury are serious manifestations of pediatric scrub typhus.

Increasing trend in pediatric scrub typhus admissions in a tertiary care hospital, South India: Clinical profile and outcomes of cases over four years, 2011-2014.

“…Studies from other parts of India and other countries have reported a similar age distribution. 9,10,[18][19][20] Male preponderance among the admitted cases was reported in several studies in contrast to our study finding. Exact reason for this finding is not known.…”

“…6,[18][19][20] Similar to other studies, fever was the predominant symptom in our study. [1][2][3][4][5][6][7][8][9][10][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In the present study facial puffiness was noted in 45.2% of the cases, however higher proportion up to 74.62% have been reported in literature. 9,10.18,19,20 Hepatomegaly (88.6%), splenomegaly (64.5%) followed by lymphadenopathy (48.7%) and edema (43.4%) were the common signs found in this study.…”

“…This may be related to prevailing favorable conditions in rural areas related to source, vector and transmission dynamics of the scrub typhus. [4][5][6]10,[18][19][20][21][22][27][28][29][30][31][32] Other important finding similar to other studies was the increase in cases during cooler months from September to January. Rainy seasons favors growth of grassy vegetation which helps in increase in vector population and interaction with human host.…”

“…Very few studies (with small sample size) from India are available on clinical features and outcome in children, though none of them studied the trends in admissions of scrub typhus cases. [17][18][19][20][21][22] There is anecdotal evidence on increase in pediatric scrub typhus cases in south India in recent years. Inpatient admissions related to scrub typhus can be taken as a proxy measure for increasing burden of scrub typhus as community based surveys are not feasible.…”

Does the presence of an eschar correlate with severity of scrub typhus infection?

“…[3,4] It is a clinically important disease because it is associated with many serious complications and has a mortality rate of 14-20%. [5][6][7] Its incidence in certain parts of India reaches endemic proportions and accounts for up to 50% of undifferentiated febrile illness in those areas during cooler months of the year. [3,7] The clinical finding of a pathognomonic eschar in a patient with febrile illness is the most important clue to the diagnosis of ST.…”