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Characteristics of Pediatric Scrub Typhus Eschar in South Indian Children
Thirunavukkarasu Arun Babu1, Vijayasankar Vijayadevagaran1, Shanthi Ananthakrishnan1
1Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Puducherry, India.
Insights
Identifying eschar in children with scrub typhus is key for early diagnosis. Examination of skin folds, especially in the groin and axillae, is crucial for detecting this diagnostic sign.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Epidemiology
Background:
- Early diagnosis of scrub typhus in children is crucial for timely treatment.
- Knowledge of eschar location aids in diagnosing scrub typhus in pediatric patients.
Purpose of the Study:
- To determine the frequency and anatomical distribution of eschar in children diagnosed with scrub typhus.
- To assess the correlation between eschar presence and clinical characteristics, severity, and treatment outcomes.
Main Methods:
- A retrospective analysis of 107 children under 12 years with confirmed scrub typhus.
- Data collected included eschar presence, location, and associated clinical findings like lymphadenopathy.
Main Results:
- Eschar was present in 34.6% of pediatric scrub typhus cases.
- The most common eschar locations were inguinal (35.1%), genitalia/buttocks (27%), and axilla (18.9%).
- Lymphadenopathy was observed in 67.5% of patients with eschar; eschar presence did not correlate with disease severity or treatment response.
Conclusions:
- Careful examination for eschar, particularly in skin folds (groin, genitalia, axillae), can facilitate early scrub typhus diagnosis in febrile children.
- The presence of lymphadenopathy should prompt a thorough search for eschar in the corresponding lymphatic drainage area.
Background:
Knowledge of anatomic location of eschar is useful in diagnosing scrub typhus early in children and to initiate appropriate treatment.
Methods:
All children younger than 12 years of age admitted with confirmed diagnosis of scrub typhus over a 17-month period were included and the presence of eschar and other characteristics were recorded and analyzed.
Results:
Of 107 confirmed patients with scrub typhus, 37 (34.6%) presented with eschar. The site of eschar distribution was the face, 2.7%; neck, 5.4%; axilla, 18.9%; trunk, 10.8%; inguinal, 35.1%; and genitalia and buttocks, 27%. Lymphadenopathy was associated with 67.5% of eschars. The presence of eschar did not correlate with severity, complications, or response to therapy.
Conclusion:
Careful examination for eschar in children presenting with fever, particularly in the skin folds of the groin, genitalia, and axillae, can aid in early diagnosis of scrub typhus. Lymphadenopathy should alert the clinician to the possibility of finding an eschar in the drainage area.
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