Severe paediatric scrub typhus with complications: a case report and literature review

Area of Science:

• Pediatric Infectious Diseases
• Critical Care Medicine
• Diagnostic Microbiology

Background:

• Scrub typhus, a rickettsial disease, is typically seen in adults, with severe complications rare in children.
• Pediatric scrub typhus can manifest with serious conditions including septic shock, acute respiratory distress syndrome (ARDS), and hemophagocytic lymphohistiocytosis (HLH).

Purpose of the Study:

• To document a rare, severe pediatric case of scrub typhus with multiple organ complications.
• To highlight the diagnostic utility of metagenomic next-generation sequencing (mNGS) in pediatric scrub typhus.
• To emphasize the importance of multidisciplinary care in managing severe pediatric scrub typhus.

Main Methods:

• Case presentation of an 8-year-old patient with scrub typhus.
• Diagnostic confirmation using metagenomic next-generation sequencing (mNGS) on blood and lung samples.
• Treatment regimen including antibiotics (doxycycline, rifampicin), mechanical ventilation, plasma exchange, CRRT, and chemotherapy.

Main Results:

• Confirmed diagnosis of scrub typhus in a pediatric patient presenting with fever, hepatosplenomegaly, and lymphadenopathy.
• First reported instance of scrub typhus identified in lung tissue using mNGS, aiding early detection.
• Successful patient recovery following intensive, multidisciplinary supportive care and antibiotic treatment.

Conclusions:

• Severe scrub typhus in children, though uncommon, requires prompt diagnosis and aggressive management.
• mNGS is a valuable tool for diagnosing scrub typhus, even in challenging cases involving lung tissue.
• Multidisciplinary supportive care is critical for improving outcomes in severe pediatric scrub typhus cases.