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Pediatric Scrub Typhus Manifesting with Multisystem Inflammatory Syndrome: A New Cause for Confusion or Concern-A

Parveen Bhardwaj1, Mangla Sood1, Rajender Singh1

  • 1Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|July 15, 2022
PubMed

Insights

Pediatricians should consider scrub typhus in children with multisystem inflammatory syndrome (MIS-C), especially in developing nations. Misdiagnosis and delayed treatment of scrub typhus can be fatal, even with MIS-C therapies.

Area of Science:

  • Pediatric Infectious Diseases
  • Critical Care Medicine
  • Tropical Medicine

Background:

  • The COVID-19 pandemic introduced multisystem inflammatory syndrome in children (MIS-C).
  • Developing nations face challenges in differentiating MIS-C from endemic tropical fevers.
  • Scrub typhus presents a diagnostic challenge due to overlapping symptoms with MIS-C.

Observation:

  • This case series highlights pediatric patients presenting with symptoms mimicking MIS-C.
  • Clinical presentation included features common to both MIS-C and severe febrile illnesses.
  • Diagnostic delays occurred due to initial focus on MIS-C criteria.

Findings:

  • Scrub typhus, a rickettsial infection, was identified as a critical differential diagnosis.
  • Failure to detect scrub typhus via cultures and serology can lead to incorrect treatment.
  • Administration of steroids or immunomodulatory agents without diagnosing underlying bacterial infection can be fatal.

Implications:

  • Pediatricians must maintain a high index of suspicion for tropical diseases like scrub typhus in MIS-C-like presentations.
  • Early and accurate diagnosis of scrub typhus is crucial for appropriate treatment and improved outcomes.
  • Awareness of overlapping symptomatology is vital to prevent potentially fatal treatment errors in resource-limited settings.
Keywords:
ChildMultisystem inflammatory syndrome in childrenRickettsiaScrub typhusSevere acute respiratory syndrome

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