Clinical Profile and Outcome of Children with Scrub typhus: A Tertiary Care Centre Observation

Area of Science:

• Pediatric Infectious Diseases
• Tropical Medicine
• Clinical Microbiology

Background:

• Scrub typhus, caused by Orientia tsutsugamushi, is an acute febrile illness.
• It can lead to severe multi-organ dysfunction, particularly in pediatric populations.
• Understanding its clinical spectrum and treatment response is crucial for effective management.

Purpose of the Study:

• To delineate the clinical presentation and complications of scrub typhus in children.
• To evaluate the response to doxycycline therapy in relation to disease severity.
• To determine the mortality rate associated with scrub typhus in pediatric patients.

Main Methods:

• A prospective observational study was conducted on children aged 1-18 years diagnosed with scrub typhus.
• Diagnosis was confirmed by clinical presentation and positive IgM antibody titers.
• Data on clinical features, complications, treatment, and outcomes were collected.

Main Results:

• Fever, abdominal pain, vomiting, cough, and rash were common presenting symptoms in 70 children.
• Hepatomegaly, pallor, conjunctival congestion, and splenomegaly were predominant on examination.
• Severe complications included fluid retention, respiratory distress, myocarditis, hemophagocytic lymphohistiocytosis, shock, acute kidney injury, and encephalitis.
• Patients with multiple severe manifestations showed a significantly higher probability of delayed response to doxycycline (P = 0.001).
• The overall mortality rate was 4.3%.

Conclusions:

• Scrub typhus is a significant pediatric infection with potential for multi-system involvement.
• Early administration of parenteral doxycycline combined with comprehensive supportive care is vital for improving patient outcomes.
• Aggressive management of severe manifestations is essential to reduce morbidity and mortality.