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Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis: Not a Rare Entity in Pediatric Age Group

Ankika Basu1, Satyabrata Roy Chowdhoury1, Mihir Sarkar1

  • 1Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal 700073, India.

Journal of Tropical Pediatrics
|February 6, 2021
PubMed

Insights

Scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in children is increasingly recognized. Younger age, prolonged fever, and complications like ARDS and MODS are key predictors, with doxycycline treatment often effective.

Area of Science:

  • Pediatric Infectious Diseases
  • Hematology
  • Immunology

Background:

  • Scrub typhus is a significant cause of febrile illness in children.
  • Hemophagocytic lymphohistiocytosis (HLH) is a severe, life-threatening hyperinflammatory syndrome.
  • Understanding scrub typhus-associated HLH in pediatric patients is crucial for timely diagnosis and management.

Purpose of the Study:

  • To investigate the demographic, clinical, and laboratory characteristics of pediatric patients with scrub typhus-associated HLH.
  • To compare the outcomes of HLH patients with non-HLH scrub typhus patients.
  • To identify clinical predictors of HLH in children with scrub typhus.

Main Methods:

  • A prospective observational study was conducted over one year in a tertiary care hospital.
  • Pediatric patients (1 month to 12 years) with confirmed scrub typhus (IgM ELISA positive) were enrolled.
  • HLH diagnosis was based on the HLH-2004 criteria, with detailed clinical and laboratory data collected.

Main Results:

  • Out of 58 scrub typhus cases, 18 (31%) had HLH. All HLH patients presented with anemia, thrombocytopenia, and hyperferritinemia.
  • Complications such as acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) were significantly higher in the HLH group.
  • Clinical predictors for HLH included younger age (<3 years), prolonged fever (>7 days), convulsions, ARDS, and MODS.

Conclusions:

  • Scrub typhus-associated HLH is an emerging concern in pediatric populations.
  • Clinicians should be vigilant for HLH in children with scrub typhus, especially those with risk factors like prolonged fever and severe complications.
  • Primary treatment of scrub typhus is paramount, and immunomodulatory therapy may not always be necessary.
Abstract

Keywords:
childrenhemophagocytic lymphohistiocytosisscrub typhus

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