ISSN - 0973-0958
   
 
Clinical and Laboratory Features of Rickettsial diseases in children in South India
Sandeep Kumar, Shrikiran Aroor, Pushpa Gurudas Kini, Suneel Mundkur, Manaswita Gadiparthi.
Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
 
Abstract

Objective: To determine the characteristic clinical and laboratory features that help in differentiating rickettsial fever from other tropical febrile illnesses.

Methods and Material: A prospective observational study was conducted in children aged 1 month to 18 years with undifferentiated fever for 5 days admitted to the pediatric department of a tertiary care hospital from November 2015 to July 2017. Rickettsial fever was considered in those with positive Weil - Felix test with OX titer of > 1:160 (OX K for scrub typhus, OX 19 for epidemic/endemic typhus and OX 2 for spotted fever group) and/or positive IgM scrub typhus ELISA. Presenting clinical features, laboratory parameters, complications and response to therapy were analyzed.

Results: Of 324 children admitted with fever, 139 (42.9%) children were diagnosed to have rickettsial disease of which 15 children were excluded due to co-infections. Age ranged from 10 months to 17 years with a mean age of 7.2 ± 4.56 years. Common clinical manifestations were fever (100%), vomiting (46.8%), hepatosplenomegaly (39.5%), isolated splenomegaly (38.7%), pallor (35.5%), headache (31.5%), myalgia (30.6%), breathlessness (4.8%), edema (33.9%), abdominal pain (22.6%), conjunctival congestion (21%), cough (19.4%), skin rash (18.5%), eschar (17%), seizures (9.7%), altered sensorium (8.9%), and lymphadenopathy (8.9%). Complications seen were meningitis/meningoencephalitis (9%), pneumonia (5%), acute respiratory distress syndrome (ARDS) (4%), gangrene (2%), myocarditis (1.6%), acute kidney injury (AKI) (1.6%) and stroke (1.6%). Common laboratory features were elevated liver enzymes (60.5%), thrombocytopenia (54%), hypoalbuminemia (53.2%), anemia (47.6%), elevated CRP (46%), leucocytosis (41.9%), and hyponatremia (38.7%). There was no mortality and all recovered. Ninety four (76%) children were diagnosed with scrub typhus, 25 children were included in other typhus group and 5 children were diagnosed as spotted fever. Vomiting, hepatosplenomegaly, anemia, myalgia, skin rash were seen more common in patients with spotted or endemic typhus whereas eschar, seizures was seen only in children with scrub typhus. Elevated CRP, hypoalbuminemia and elevated liver enzymes were seen in all patients with spotted fever.

Conclusion: Splenomegaly is a common finding in children with rickettsial fever. Eschar is seen only in patients with scrub typhus. Elevated liver enzymes, hypoalbuminemia, leucocytosis, thrombocytopenia, elevated CRP and hyponatremia are the common laboratory features that point towards the diagnosis of rickettsial disease which is seen in all patients with spotted fever.
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