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Clinical Profile and Therapeutic Response of Scrub Typhus in Children: A Recent Trend from Eastern India
Suprit Basu1, Arpan Saha1, Sumantra Sarkar1
1Department of Pediatric Medicine, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), 244, AJC Bose Road, Kolkata, India.
Insights
Scrub typhus in children presents with diverse symptoms, including neurological issues. Early doxycycline treatment is crucial for favorable outcomes, especially in scrub meningoencephalitis cases.
Area of Science:
- Pediatric infectious diseases
- Tropical medicine
- Clinical microbiology
Background:
- Scrub typhus, a zoonotic disease caused by Orientia tsutsugamushi, is prevalent in Eastern India.
- Children with scrub typhus exhibit a range of clinical presentations and potential complications.
Purpose of the Study:
- To evaluate clinical and laboratory findings in pediatric scrub typhus cases.
- To identify common complications and assess therapeutic responses to doxycycline.
Main Methods:
- A prospective, observational study enrolled children under 12 with suspected scrub typhus.
- Diagnosis was confirmed via IgM serology or Weil-Felix reaction (OXK ≥ 1/80).
- Confirmed cases received oral doxycycline (4.5 mg/kg/day).
Main Results:
- Of 94 children, 61 had confirmed scrub typhus (mean age 6.1 years).
- Neurological presentation (meningoencephalitis) occurred in 34.4% of cases.
- Common symptoms included vomiting, abdominal pain, lymphadenopathy, hepatosplenomegaly, pedal edema, and eschar.
Conclusions:
- Scrub meningoencephalitis was observed with higher incidence and showed a good response to doxycycline.
- Prompt empirical doxycycline therapy is vital for managing scrub typhus in children and can be life-saving.
Objective:
The aim of this study was to assess the clinico-laboratory parameters, complications and therapeutic responses in children with scrub typhus in Eastern India.
Materials And Methods:
In this prospective, observational study, all children (age, <12 years) with suspected scrub typhus with a compatible clinical scenario were enrolled consecutively over six months. Cases confirmed by means of a positive IgM serology or a positive Weil-Felix reaction (OXK = 1/80 or above) were administered enteral doxycycline (4.5 mg/kg/day).
Results:
Out of 94 recruited children, 61 had confirmed scrub typhus (mean age = 6.1 years, M:F = 1.1:1) with or without complications and having a considerably higher incidence of neurological presentation (meningoencephalistis n = 21, 34.4%). The most frequent manifestations included vomiting (n = 39, 63.9%), abdominal pain (n = 33, 54.1%), lymphadenopathy (n = 36, 59%), hepatosplenomegaly (n = 32, 52.5%), pedal edema (n = 32, 52.5%) and eschar formation (n = 30, 49.2%). Low hemoglobin levels, leukocytosis, thrombocytopenia, hypoalbuminemia, hyponatremia, increased liver enzymes and increased C-reactive protein were associated with delayed defervescence (>48 h).
Conclusion:
Scrub meningoencephalitis, with a notably higher incidence, showed favorable therapeutic response. Prompt and empiric doxycycline therapy could be lifesaving.
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