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Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity
Tri Wangrangsimakul1,2, Rachel C Greer1,2, Chulapong Chanta3
1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Insights
Pediatric scrub typhus in Thailand is severe and can be fatal, often due to delayed treatment. Improving public awareness and further research into treatment outcomes are crucial for better management of this febrile illness.
Area of Science:
- Tropical medicine
- Pediatric infectious diseases
- Epidemiology of febrile illnesses
Background:
- Scrub typhus, caused by Orientia tsutsugamushi, is a significant cause of acute febrile illness in children in rural tropical regions.
- Early diagnosis and treatment are essential for managing scrub typhus, particularly in pediatric populations.
Purpose of the Study:
- To investigate the clinical characteristics, diagnostic methods, and treatment outcomes of scrub typhus in pediatric patients in northern Thailand.
- To identify factors contributing to treatment failure and mortality in pediatric scrub typhus cases.
Main Methods:
- A study involving 60 febrile pediatric patients and 40 healthy controls in Chiang Rai Province, Thailand.
- Diagnosis confirmed using polymerase chain reaction (PCR) for O. tsutsugamushi DNA and indirect immunofluorescence assay (IFA) for IgM titers.
- Collection of demographic, clinical, and laboratory data, with a 1-year follow-up period.
Main Results:
- Scrub typhus was confirmed in 35 (58%) of pediatric patients, presenting with fever, eschar, cough, and tachypnea.
- Complications included hepatitis, severe thrombocytopenia, pneumonitis, and acute respiratory distress syndrome.
- Treatment failure occurred in 23% of patients, with one death, highlighting potential delays in appropriate antibiotic administration.
Conclusions:
- Pediatric scrub typhus in northern Thailand is frequently severe and potentially fatal, with treatment delays being a likely contributing factor.
- Further research is needed to understand bacterial, pharmacologic, and immunologic factors influencing treatment outcomes.
- Prioritizing public awareness and improved diagnostic and treatment strategies is essential for reducing morbidity and mortality.
Background:
Scrub typhus, caused by Orientia tsutsugamushi, is a major cause of acute febrile illness in children in the rural tropics.
Methods:
We recruited 60 febrile pediatric patients with a positive scrub typhus rapid diagnostic test result and 40 healthy controls from Chiang Rai Province in northern Thailand. Diagnosis was confirmed by the detection of (1) O. tsutsugamushi-specific DNA in blood or eschar samples with a polymerase chain reaction assay, (2) a fourfold rise in immunoglobulin M (IgM) titer to ≥1:3200 in paired plasma samples with an indirect immunofluorescence assay (IFA), or (3) a single IgM titer of ≥1:3200 in an acute plasma sample with an IFA. Demographic, clinical, and laboratory data were collected, and patients were followed up for 1 year.
Results:
Diagnosis was confirmed in 35 (58%) of 60 patients, and all controls tested negative for scrub typhus. Patients with confirmed scrub typhus had clinical symptoms, including fever (35 of 35 [100%]), eschar (21 of 35 [60%]), cough (21 of 35 [60%]), tachypnea (16 of 35 [46%]), lymphadenopathy (15 of 35 [43%]), and headache (14 of 35 [40%]). Only 4 (11%) of 35 patients received appropriate antibiotic treatment for scrub typhus before admission. The median fever-clearance time was 36 hours (interquartile range, 24-53 hours). Complications observed include hepatitis (9 of 35 [26%]), severe thrombocytopenia (7 of 35 [20%]), pneumonitis (5 of 35 [14%]), circulatory shock (4 of 35 [11%]), and acute respiratory distress syndrome (3 of 35 [9%]). Treatment failure, defined by failure to defervesce within 72 hours of antibiotic treatment initiation, was noted in 8 (23%) of 35 patients, and 1 (3%) of the 35 patients died. No evidence of relapse or reinfection was found.
Conclusion:
Pediatric scrub typhus in northern Thailand is often severe and potentially fatal with delays in treatment a likely contributing factor. Additional studies to investigate the bacterial, pharmacologic, and immunologic factors related to treatment outcome along with measures to improve public awareness should be prioritized.
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