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Clinical features and risk factors for severe pediatric scrub typhus in Liangshan Prefecture, China: A retrospective
Yuanyuan Hua1,2, Yan Zhang3, Jimin Zhou1,2
1Department of Pediatrics, The First People's Hospital of Liangshan Prefecture, Xichang, People's Republic Of China.
Insights
Pediatric scrub typhus in resource-limited areas is characterized by fever and eschar. Low albumin, hemoglobin, and platelet counts are key indicators of severe disease, prompting early intervention.
Area of Science:
- Infectious Diseases
- Pediatrics
- Epidemiology
Background:
- Scrub typhus is a significant public health concern, particularly in resource-limited regions.
- Pediatric scrub typhus presents unique challenges in diagnosis and management.
- Understanding risk factors for severe disease is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze clinical characteristics of pediatric scrub typhus in Liangshan Prefecture.
- To identify risk factors associated with severe scrub typhus in children.
- To guide early diagnosis and intervention strategies in resource-limited settings.
Main Methods:
- A retrospective study of 103 pediatric scrub typhus cases was conducted.
- Patients were categorized into severe and non-severe groups based on clinical outcomes.
- Demographics, clinical features, and laboratory parameters were compared; univariate logistic regression was used to identify risk factors.
Main Results:
- Fever and eschar/ulcer were universal findings in pediatric scrub typhus.
- Severe cases showed significantly higher CRP, AST, and LDH levels.
- Decreased albumin, hemoglobin, and platelet counts were identified as significant risk factors for severe disease.
Conclusions:
- Fever, eschar/ulcer, and specific laboratory derangements aid in diagnosing scrub typhus.
- Elevated CRP and LDH, along with reduced platelets, fibrinogen, hemoglobin, and albumin, indicate severe disease.
- Early recognition of these indicators can lead to timely intervention and improved prognosis in pediatric scrub typhus.
Objective:
This study aimed to analyze the clinical characteristics and identify risk factors for severe disease in pediatric scrub typhus in Liangshan Prefecture, a resource-limited region, to facilitate early diagnosis and intervention, thereby improving outcomes and reducing mortality.
Methods:
We conducted a retrospective study of 103 children with confirmed scrub typhus admitted to a major hospital in Liangshan between July 2023 and December 2024. Patients were classified into severe and non-severe groups. Demographics, clinical features, and laboratory parameters were compared. Univariate logistic regression was performed to identify laboratory parameters associated with disease severity. Due to the limited number of severe cases (n = 12), multivariable analysis was not performed.
Results:
A total of 103 children were enrolled, comprising 92 mild and 11 severe cases. The majority of children (53.4%) were aged 5-11 years. A distinct seasonal peak was observed from August to September (84.5%). Universal clinical manifestations included fever (100%) and eschar/ulcer (100%). Compared to the mild group, severe cases demonstrated significantly higher levels of CRP, AST, and LDH, and more pronounced reductions in hemoglobin (Hb), platelet count(PLT), fibrinogen, and albumin (all P < 0.05). Univariate analysis using categorized laboratory parameters identified decreased albumin (OR: 20.54, 95% CI: 4.07-376.76, P < 0.001), decreased hemoglobin (OR: 4.53, 95% CI: 1.38-15.87, P = 0.011), and decreased platelet count (OR: 3.20, 95% CI: 1.03-12.22, P = 0.037) as significant risk factors for severe disease.
Conclusion:
In resource-limited settings during scrub typhus season, the constellation of fever, eschar/ulcer, hepatomegaly, lymphadenopathy, and characteristic laboratory derangements supports the diagnosis. Among these, elevated CRP and LDH, coupled with reductions in PLT, fibrinogen, Hb, and particularly albumin, should alert clinicians to severe disease, enabling early intervention and improved prognosis.
