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Clinical profile and outcomes of pediatric scrub typhus associated with elevated hepatic transaminases
Dinesh Kumar Narayanasamy1, Thirunavukkarasu Arun Babu2, Jean Fredrick3
1Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Karaikal, 605 006, India.
Insights
Elevated hepatic transaminase (HT) in children with scrub typhus (ST) is common and linked to severe disease. These children experienced prolonged fever and hospital stays, indicating a worse clinical outcome.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Clinical Microbiology
Background:
- Hepatic transaminase (HT) elevation is a frequent finding in children diagnosed with scrub typhus (ST).
- The clinical significance and implications of elevated HT in pediatric ST cases remain largely unknown.
- Understanding this association is crucial for managing ST in children.
Purpose of the Study:
- To investigate the clinical profile and outcomes of pediatric patients with scrub typhus (ST) who exhibit elevated hepatic transaminase (HT) levels.
- To compare the clinical characteristics and disease progression of ST children with and without elevated HT.
Main Methods:
- A prospective cohort study included children under 12 years old with fever for at least 5 days and positive IgM serology for ST.
- Clinical findings, laboratory results, and patient outcomes were systematically recorded and analyzed.
- Children with elevated HT were compared to those with normal HT levels using logistic regression.
Main Results:
- Of 560 children with ST, 45.8% had elevated HT. Common symptoms included cough, vomiting, and myalgia; signs included hepatomegaly, splenomegaly, and lymphadenopathy.
- Thrombocytopenia and anemia were frequent laboratory abnormalities. Severe ST forms, particularly pneumonia, were observed in 45.5% of cases.
- Elevated HT was associated with generalized lymphadenopathy, ascites, thrombocytopenia, and hypoalbuminemia.
Conclusions:
- Elevated hepatic transaminase levels in children with scrub typhus correlate with disease severity and duration of untreated fever.
- Children with elevated HT experienced delayed fever resolution and longer hospitalizations.
- HT elevation serves as a potential indicator for more severe scrub typhus presentations in pediatric populations.
Background:
Hepatic transaminase (HT) elevation is frequently seen in children with scrub typhus (ST), but the clinical implication of this common finding is not known.
Objective:
To describe the clinical profile and outcome of pediatric ST with elevated hepatic transaminase.
Methods:
In this prospective cohort study, all children < 12 years of age presenting with fever for ≥ 5 days and positive immunoglobulin M (IgM) serology for ST were included. Clinical findings, laboratory features and outcomes of children with elevated HT were compared with those who had normal HT.
Results:
Of 560 ST positive children included, 257 (45.8%) had associated HT elevation. The common age group affected was 5 to 12 years of age (54.9%). Most of the children came during the second week of fever (68.5%) with mean duration of fever of 9.1 days. The common initial presenting symptoms were cough (77.8%), vomiting (65%) and myalgia (59.1%) and signs were hepatomegaly (64.2%), splenomegaly (57.6%) and generalized lymphadenopathy (54.1%). Eschar was seen in 49.8% of children. Thrombocytopenia (58%) and anemia (49%) were the frequently seen laboratory abnormalities. Severe forms of ST were seen in 45.5% children, of which pneumonia was most common. The fever clearance time (48 ± 19.2 h) and mean duration of hospital stay (6.7 ± 3.3 days) were prolonged in these children. On logistic regression analysis, generalized lymphadenopathy (p = 0.002), ascites (p = 0.037), thrombocytopenia (p < 0.001) and hypoalbuminemia (p = 0.023) were found to be associated with HT elevation in these children.
Conclusions:
Hepatic transaminase (HT) levels increase with the duration of untreated fever and is found to be associated with severe forms of scrub typhus. Children with elevated HT have delay in fever defervescence and their duration of hospital stay was prolonged.
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