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Scrub typhus in rural Rajasthan and a review of other Indian studies
Rupesh Masand1, Ritesh Yadav1, Alok Purohit1
1a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.
Insights
Scrub typhus is a significant cause of febrile illness in children in rural Rajasthan. Early diagnosis and prompt treatment with doxycycline are crucial for preventing severe complications and improving outcomes.
Area of Science:
- Medical Research
- Infectious Diseases
- Pediatrics
Background:
- Scrub typhus, an acute febrile illness, is increasingly reported across India.
- Rajasthan has recently emerged as an affected region, necessitating local data.
Purpose of the Study:
- To document a series of pediatric scrub typhus cases from rural Rajasthan.
- To analyze clinical presentations, diagnostic methods, and treatment responses.
Main Methods:
- Retrospective review of pediatric patients admitted to a tertiary-care hospital over an 8-month period.
- Inclusion criteria: clinical or serological scrub typhus confirmation, exclusion of other febrile illnesses.
- Investigations included IgM-ELISA for scrub typhus; treatment with doxycycline or chloramphenicol.
Main Results:
- Thirty pediatric patients met the criteria; mean age was 8.56 years.
- Fever (100%), headache (66%), and hepatosplenomegaly (60%) were common; eschar (3.3%) and rash (10%) were rare.
- IgM-ELISA was positive in 93.3%; 90% responded to doxycycline within 72 hours. Mortality was 6.6% due to ARDS and renal failure.
Conclusions:
- High index of suspicion is vital for early scrub typhus diagnosis in rural settings.
- Prompt referral and appropriate management, particularly with doxycycline, can prevent severe outcomes.
- Awareness of varied clinical presentations aids in avoiding unnecessary investigations.
Background:
Scrub typhus is an acute febrile illness which has been reported from various parts of India with Rajasthan recently joining the list of affected states.
Aim:
To report a series of paediatric scrub typhus cases from rural Rajasthan.
Study Design:
Retrospective review of children with scrub typhus admitted to the wards and paediatric intensive care unit (PICU) of a tertiary-care hospital.
Methods:
The study was undertaken over an 8-month period from May to December 2013. All patients with a clinical presentation and/or serological confirmation of scrub typhus who tested negative for malaria, enteric fever, dengue, leptospirosis and urinary tract infection (UTI) were included. A range of investigations were undertaken including IgM-ELISA for scrub typhus, followed by appropriate medical management.
Results:
Thirty patients satisfied the inclusion criteria. The mean (SD, range) age of the patients was 8·56 (3·43, 3-16) years. The most common clinical features were fever (n = 30, 100%), headache (n = 20, 66%), myalgia (n = 15, 50%), hepatosplenomegaly (n = 18, 60%) and pallor (n = 5, 16%). Typical features such as eschar and rash were observed in only one (3·3%) and three (10%) patients, respectively; none had generalised lymphadenopathy or conjunctival congestion. IgM-ELISA for scrub typhus was positive in 28 patients (93·3%) and 27 responded to doxycycline within 24-72 hours. One of the three patients who required PICU support responded to intravenous chloramphenicol and, of the other two (6·6%), one died of acute respiratory distress syndrome and the other owing to acute renal failure.
Conclusion:
A high index of suspicion is essential for early diagnosis and prevention of complications in scrub typhus together with prompt referral from rural areas to a higher centre. Awareness of the disease manifestations may further help to prevent excessive investigations in patients presenting with non-specific febrile illness and reduce the economic burden to the family and society in resource-constrained settings.
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