Validation of Clinical RGA Score in Diagnosis of Scrub Typhus at 2nd Tier Hospital of West Bengal, India

Scrub typhus is caused by arthropod-borne gram-negative obligately intracellular bacillus Orientia tsutsugamushi bite by bitten by an infected vector, a Leptotrombidium mite. An eschar at the site of chigger feeding is a classic clinical feature of scrub typhus. Scrub typhus had severe complications including jaundice, acute renal failure, acute respiratory distress syndrome etc. Laboratory investigation is the gold standard test for the diagnosis but it is not available at all point of care centers. Rathi Goodman Score (RGA) was introduced and validated to diagnose the disease at the resource-limited center. The main aim of this study is to Validation of Clinical RGA score in the diagnosis of scrub typhus at 2nd tier hospital in West Bengal. The prospective cross-sectional observational study was conducted at a tertiary care hospital from March 2021 to February 2022 on 102 pediatric patients. All the relevant clinical features and tests were done for all patients. RGA scoring system was validated with the available standard IgM ELISA test. Pets and tick exposure were found in the majority of patients. Scrub typhus was diagnosed in 69.80% of patients by IgM ELISA. Sensitivity and specificity of the scoring system with the standard test were reported at 87.32% and 64.52% in comparison with IgM ELISA in children with a cut-off of 14 respectively. Diagnostic accuracy was reported at 80.39%. We conclude that this RGA scoring system might be useful for early detection, treatment, and prevention of child mortality and morbidity from scrub typhus-type Rickettsial disease.