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Spectrum of Multiorgan Dysfunction in Scrub Typhus Infection

Vidushi Mahajan¹, Vishal Guglani¹, Nidhi Singla²

¹Department of Pediatrics, Government Medical College and Hospital, Chandigarh 160030, India.

Journal of Tropical Pediatrics

|September 4, 2021

Insights

Children hospitalized with scrub typhus experienced significantly more multiorgan dysfunction and severe systemic manifestations compared to other tropical fevers. This highlights scrub typhus as a critical diagnosis in febrile pediatric patients.

Area of Science:

Infectious Diseases
Pediatrics
Tropical Medicine

Background:

Scrub typhus is a significant cause of febrile illness in tropical regions.
Multiorgan dysfunction is a serious complication in pediatric febrile illnesses.
Differentiating scrub typhus from other tropical fevers is crucial for timely management.

Purpose of the Study:

To determine the clinical spectrum of scrub typhus in hospitalized children.
To compare the incidence of multiorgan dysfunction in scrub typhus versus other tropical fevers.
To identify key clinical manifestations associated with pediatric scrub typhus.

Main Methods:

Prospective cohort study involving children aged 2 months to 14 years with acute undifferentiated fever.
Comparison of scrub typhus IgM ELISA positive cases with IgM negative controls.
Detailed fever workup and assessment of mortality and morbidity.

Main Results:

Scrub typhus was diagnosed in 34% (76/224) of febrile children.
Significantly higher incidence of multiorgan dysfunction in scrub typhus cases (OR 3.5).
Increased rates of altered sensorium, seizures, ARDS, renal failure, meningitis, thrombocytopenia, transaminitis, and shock in scrub typhus patients.

Conclusions:

Pediatric scrub typhus is associated with severe systemic manifestations.
Hospitalized children with scrub typhus exhibit greater morbidity than those with other febrile illnesses.
Early diagnosis and management of scrub typhus are vital to prevent severe outcomes.

Read full analysis

Abstract

Objectives:

We planned this study to determine the clinical spectrum and compare incidence of multiorgan dysfunction in children hospitalized with scrub typhus with other etiologies of tropical fever.

Design:

Prospective cohort study.

Setting:

Pediatric emergency and PICU services of a university teaching hospital situated in the sub-Himalayan region.

Patient:

Children aged 2 months to 14 years with acute undifferentiated fever of more than 5 days.

Interventions:

Detailed fever workup was performed in all children. We compared scrub typhus IgM positive children (cases) with remaining febrile children who were negative for scrub IgM assay (controls) for mortality and morbidity.

Main Results:

We enrolled 224 febrile children; 76 children (34%) were positive for scrub typhus IgM ELISA. Scrub typhus group had a significantly higher incidence of multiorgan dysfunction [OR 3.5 (95% CI 2.0-6.3); p < 0.001] as compared to non-scrub typhus group requiring supportive care. The incidence of altered sensorium [OR 8.8 (95% CI 3.1-24.9)], seizures [OR 3.0 (95% CI 1.1-8.3)], acute respiratory distress syndrome [OR 17.1 (95% CI 2.1-140.1)], acute renal failure (5% vs. 0%), meningitis [OR 6.2 (95% CI 1.2-31.6)], thrombocytopenia [OR 2.8 (95% CI 1.5-5.1)], transaminitis [OR 2.7 (95% CI 1.6-4.8)], requirement of oxygen [OR 17.8 (95% CI 4.0-80.3)], positive pressure support [OR 3.7 (95% CI 1.2-10.5)] and shock requiring inotropes [OR 3.0 (95% CI 1.3-6.7)] was significantly higher in scrub typhus group as compared to the non-scrub typhus group (Table 1).

Conclusions:

Pediatric scrub typhus who were hospitalized had severe systemic manifestations when compared to other causes of fever.

Keywords:

Orientia tsutsugamushi epidemiology morbidity tsutsugamushi fever

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