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Clinico - Laboratory Profile of Scrub Typhus - An Emerging Rickettsiosis in India
Dinesh Kumar Narayanasamy1, Arul Kumaran Arunagirinathan2, Revathi Krishna Kumar2
1Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India. dinesh.paed@gmail.com.
Insights
Pediatric scrub typhus in rural India presents with fever, gastrointestinal issues, and common symptoms like cough and vomiting. Early empirical treatment with Doxycycline or Azithromycin is crucial for preventing severe complications.
Area of Science:
- Infectious Diseases
- Pediatrics
- Tropical Medicine
Background:
- Scrub typhus, a zoonotic disease caused by Orientia tsutsugamushi, poses a significant health burden in endemic areas.
- Early diagnosis and treatment are critical to prevent severe morbidity and mortality, particularly in pediatric populations.
Purpose of the Study:
- To elucidate the clinical manifestations and laboratory findings of scrub typhus in children residing in rural South India.
- To identify key indicators for early diagnosis and management of pediatric scrub typhus.
Main Methods:
- A descriptive study was conducted on 117 children diagnosed with scrub typhus (IgM ELISA positive) out of 448 admitted pediatric patients.
- Data collection occurred between November 2014 and March 2015 at a tertiary care hospital.
Main Results:
- Fever (100%), gastrointestinal symptoms (51%), cough (82%), myalgia (70%), and vomiting (68%) were prevalent. Common clinical findings included hepatomegaly (70%), splenomegaly (53%), pallor (50%), and eschar (41%).
- Key laboratory findings were leucocytosis (50%), anemia (56%), elevated SGOT/SGPT (47%), and thrombocytopenia (41%). Complications included shock (46%), myocarditis (24%), and pneumonia (16%).
- Early treatment correlated with good outcomes, including rapid recovery and zero mortality.
Conclusions:
- Regional lymphadenopathy can indicate a developing eschar, and laboratory results should be interpreted considering fever duration.
- In resource-limited settings where IgM ELISA may not be readily available, empirical treatment with Doxycycline or Azithromycin is recommended for febrile children with suggestive clinical and laboratory findings to prevent severe complications.
Objective:
To study the clinical and laboratory profile of pediatric scrub typhus in rural south India.
Methods:
This is a descriptive study of the clinical and laboratory features of 117 children with IgM ELISA proven scrub typhus out of 448 children, who were admitted in the Pediatric ward of a tertiary care hospital, during the study period of November 2014 through March 2015.
Results:
Fever was present in all 117 children, with mean duration of fever at admission as 9 d. Gastrointestinal tract was the most commonly affected system, seen in 51 % of children. Cough (82 %), myalgia (70 %), vomiting (68 %), headache (45 %) and pain abdomen (42 %) were the most common symptoms of scrub typhus. Hepatomegaly (70), splenomegaly (53 %), pallor (50 %) and eschar (41 %) were the common clinical findings in children with scrub typhus. Out of 49 children with eschar, 32 were associated with regional lymphadenopathy, which was commonly seen in axillary, neck and groin regions. Leucocytosis (50 %), anemia (56 %), increased SGOT / SGPT (47 %), thrombocytopenia (41 %), hypoalbuminemia (40 %) and hyponatremia (40 %) were the common lab features. Shock (46 %), myocarditis (24 %) and pneumonia (16 %) were the common complications seen in these children. This study showed that early treatment for scrub typhus results in a good outcome in terms of early recovery and nil mortality.
Conclusions:
Regional lymphadenopathy is a marker of hidden or developing eschar. Total count and differential count should be interpreted on the background of the duration of fever. Since IgM ELISA, which is diagnostic of scrub typhus may not be widely available, any febrile child coming from rural area with hepatosplenomegaly, pallor, eschar, generalised / regional lymphadenopathy, anemia, leucocytosis, thrombocytopenia and increased Aspartate transaminase (AST) /Alanine aminotransferase (ALT) should be started on empirical Doxycycline or Azithromycin in order to prevent life threatening complications secondary to delay in therapy.
