PANCYTOPENIA IN SCRUB TYPHUS
Kush Dev Singh Jarial
Department of Paediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
Address for Correspondence
Kush Devsinghjarial, Senior Resident, Department Of Paediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Email
kushdev.jarial@gmail.com
Two siblings, 13 years female and 11 year male child presented with high grade fever, headache, limb and abdominal pain for a week. Examination revealed generalized lymphadenopathy, splenomegaly and hepatomegaly. However there was no rash or eschcar present. Investigations are shown in following table 1. Peripheral smear for malaria, Widal test were negative in both patients and blood culture was sterile. Renal and liver function tests were normal. Scrub typhus IgM Elisa was positive in the girl but negative in the boy. Since the other sibling also had similar clinical features and even though IgM ELISA was negative, both were treated with doxycycline and improvement to hematological parameters was seen in 7 days. Defervescence of fever occurred on third day in both the patients.

Table 1: Investigations of both the patients
InvestigationsPatient 1Patient 2
AdmissionDay 3Day 7AdmissionDay 3Day 7
White cell count (cells/cumm)149012302270118012602860
Polymorphs (%)68.763.860.73663.839.9
Lymphocytes (%)21.629.534.362.434.158.5
Hemoglobin (gm/dl)8.36.97.77.57.98.3
Hematocrit (%)25.522.224.823.325.727.4
Platelet Counts (cells/cumm)76,00052,0002,11,00085,00080,0003,14,000
ESR (mm at end of 1 hour)4543 35  
Sodium (meq/l)125130 128 135
IgM ELISA Scrub TyphusPOSITIVE  NEGATIVE  


Scrub typhus is a zoonosis caused by obligate intracellular bacterium of family rickettsiaceae, the Orientia tsutsugamushi transmitted through the bite of larval mites (chiggers). One-fourth to one-half cases of scrub typhus occurs in children. Symptoms begin insidiously with a low grade fever, maculopapular generalized rash involving palm and soles, eschcar, headache, chills and anorexia, progressing to an unremitting fever accompanied by a severe headache, generalised lymphadenopathy, hepatosplenomegaly and rarely leading to multiorgan dysfunction. Among various serological tests available Weil Felix and IgM ELISA are commonly used tests in developing countries. (1) Scrub typhus is often associated with various hematological abnormalities such as leucocytosis, anemia and thrombocytopenia. Pancytopenia is a rare occurrence in scrub typhus and is often related to hemophagocytosis. (2-5) Early chemotherapy for scrub typhus associated with pancytopenia usually leads to uneventful recovery, but prognosis is very poor if not treated. (4,5)

To conclude scrub typhus can presents as acute febrile illness of mild to moderate illness with pancytopenia in endemic areas and empirical therapy for scrub typhus can be considered in patients with clinically features sugesstive of scrub typhus where specific diagnostic for scrub typhus are not available.
Funding
None
Conflict of Interest
None
References :
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Last Updated : Saturday, June 01, 2013 Vol 10 Issue 6 Art #30
DOI: 10.7199/ped.oncall.2013.30
How to Cite URL :
Jarial S D K. PANCYTOPENIA IN SCRUB TYPHUS. Pediatric Oncall [serial online] 2013[cited 2013 June 1];10. Art #30. Available From : http://www.pediatriconcall.com/Journal/Article/FullText.aspx?artid=560&type=J&tid=&imgid=&reportid=17&tbltype=
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