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Clinical profile of scrub typhus in children

Sengottaiyan Palanivel1, Krishnamoorthi Nedunchelian, Varadharajan Poovazhagi

  • 1Department of Pediatrics, Institute of Child Health and Hospital for Children, Egmore, Chennai-8, Tamil Nadu, India. drpalanivel84@gmail.com

Indian Journal of Pediatrics
|March 1, 2012
PubMed

Insights

Scrub typhus in children often presents with fever, rash, and hepatosplenomegaly. Early empirical treatment with doxycycline or azithromycin is crucial for survival, as evidenced by a 11.94% mortality rate in this urban study.

Area of Science:

  • Pediatric Infectious Diseases
  • Rickettsial Infections
  • Clinical Epidemiology

Background:

  • Scrub typhus, caused by Orientia tsutsugamushi, is a significant public health concern in many parts of Asia.
  • Early diagnosis and treatment are vital to prevent severe complications and mortality.
  • Understanding the clinical profile in specific urban settings is essential for timely management.

Purpose of the Study:

  • To elucidate the clinical characteristics and outcomes of scrub typhus cases in pediatric patients admitted to an urban referral center.
  • To identify key clinical features and complications associated with scrub typhus in children.
  • To evaluate the effectiveness of empirical antibiotic therapy.

Main Methods:

  • A descriptive study was conducted on 67 children diagnosed with scrub typhus between October 2010 and March 2011.
  • Diagnosis was confirmed using IgM ELISA.
  • Clinical data, including symptoms, physical findings, laboratory results, and treatment outcomes, were collected and analyzed.

Main Results:

  • Fever was universal; eschar (46%) and rash (35%) were common. Hepatosplenomegaly (80%) and pallor were frequent. Key complications included thrombocytopenia (77%), elevated liver enzymes (64%), pleural effusion (61%), ascites (47%), shock (45%), and respiratory failure (34%).
  • Severe manifestations such as acute renal failure, hepatic failure, and multi-organ dysfunction syndrome (MODS) were observed in 10% of cases. The overall mortality rate was 11.94%, with causes including shock, ARDS, and MODS.
  • Antibiotics used were doxycycline and azithromycin.

Conclusions:

  • Scrub typhus should be suspected in children presenting with acute febrile illness, rash, hepatosplenomegaly, lymphadenopathy, and signs of capillary leak.
  • Prompt empirical treatment with doxycycline or azithromycin is life-saving and can significantly reduce morbidity and mortality.
  • This study highlights the importance of early recognition and management of scrub typhus in urban pediatric populations.
Abstract

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