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Mortality and complications of scrub typhus in the paediatric population: a systematic review and meta-analysis

Kaushik Mukhopadhyay1, Samir Chakrabarty2, Chandan Chatterjee1

  • 1Pharmacology, ESIC PGIMSR & ESIC Medical College, Diamond Harbour Road, Joka, Kolkata 700104, West Bengal, India.

Transactions of the Royal Society of Tropical Medicine and Hygiene
|October 1, 2021
PubMed

Insights

Scrub typhus in children has a 1.1% case fatality rate, with mortality declining recently. Hepatitis, shock, and pneumonia are common complications, while multi-organ dysfunction drives mortality.

Area of Science:

  • Pediatric infectious diseases
  • Epidemiology
  • Public health

Background:

  • Scrub typhus is a significant cause of treatable febrile illness in children, often leading to severe complications and mortality.
  • Despite its impact, comprehensive data on pediatric scrub typhus case fatality and complication patterns are limited.

Purpose of the Study:

  • To systematically review and estimate the case fatality risk (CFR) of scrub typhus in children.
  • To analyze the common complications and their impact on mortality in pediatric scrub typhus cases.

Main Methods:

  • Systematic review of original articles published between 1990 and 2020.
  • Pooled prevalence calculation using a random effects model (restricted maximum likelihood method) with R statistical software.
  • Reporting of pooled case fatality rate and its 95% confidence intervals (CIs).

Main Results:

  • Thirty-seven articles involving 3329 children were included. The overall CFR was 1.1% (95% CI 0.05 to 2%).
  • A declining mortality trend was observed over the last five years.
  • Hepatitis (30.68%), pneumonia (14.71%), acute kidney injury (13.72%), and shock (14.45%) were the most frequent complications. Multi-organ dysfunction syndrome significantly contributed to mortality.

Conclusions:

  • Scrub typhus presents a substantial but treatable risk to children, with a low overall CFR but significant complication burden.
  • Hepatitis and pneumonia are prevalent complications, and multi-organ dysfunction syndrome is a key driver of mortality.
  • The declining mortality trend suggests potential improvements in management or earlier diagnosis, warranting continued surveillance.

Keywords:
childrencomplicationsmortalityorientia tsutsugamushirickettsiascrub typhus

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