Clinical profile and predictors of therapeutic outcome with azithromycin in pediatric scrub typhus: A study from...

Area of Science:

• Pediatric Infectious Diseases
• Microbiology
• Clinical Pharmacology

Background:

• Scrub typhus is a significant cause of febrile illness in children, often presenting with diverse symptoms and potential for severe complications.
• Early diagnosis and appropriate antibiotic therapy are critical for favorable outcomes in pediatric scrub typhus.
• Azithromycin is a macrolide antibiotic with activity against Orientia tsutsugamushi, the causative agent of scrub typhus.

Purpose of the Study:

• To evaluate the efficacy and safety of a single empirical dose of azithromycin in children diagnosed with scrub typhus.
• To identify clinical and laboratory predictors of delayed treatment response and complications in pediatric scrub typhus.

Main Methods:

• Prospective study enrolling 189 children (1 month to 12 years) with positive IgM ELISA for scrub typhus.
• Administration of a single empirical dose of azithromycin (10 mg/kg).
• Clinical assessment, symptom monitoring, and multivariate logistic regression analysis to identify predictors of delayed response.

Main Results:

• Remarkable treatment response with a mean defervescence of 32 hours and no mortality observed.
• Common symptoms included fever, shortness of breath, altered sensorium, and hepatosplenomegaly.
• Hepatic, neurological, and cardiovascular complications occurred in approximately 46% of children.
• Predictors of delayed response included shortness of breath, altered sensorium, hepatosplenomegaly, meningeal signs, severe anemia, leucocytosis, and hyponatremia.

Conclusions:

• Empirical azithromycin administration based on clinical suspicion of scrub typhus is effective and potentially lifesaving in children.
• Hepatic, neurological, and cardiovascular complications represent an emerging trend in pediatric scrub typhus.
• Identifying predictors of delayed response can guide closer monitoring and timely intervention.