Scrub typus in children: clinical profile and complications

ORIGINAL ARTICLE

SCRUB TYPUS IN CHILDREN: CLINICAL PROFILE AND COMPLICATIONS

Shikha Khandelwal, Jitendra Kumar Meena, B S Sharma.

Department of Pediatrics, Sir Padampat Mother and Child Health Institute, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.

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Abstract
Aim: To describe the clinical and laboratory manifestations of scrub typhus in children.
Materials and Methods: One hundred eighty three children with undiagnosed febrile illness from September 2014 to December 2014 were included in the study. All patients were tested for scrub typhus using a commercial Elisa kit for specific IgM antibodies against Orientia tsutsugamushi.
Results: Fifty two (28.4%) patients had positive IgM antibodies against O. tsutsugamushi. Common clinical feature were fever in 52 (100%), hepatomegaly in 34 (65.3%), nausea /vomiting in 23 (44.2%), lymphadenopathy in 22 (42.3%), abdominal pain and splenomegaly each in 21 (40.3%), generalized swelling in 17 (32%) and headache in 12 (23%) patients. Eschar was seen in one patient only. Among the laboratory parameters raised SGOT was seen in 49 (94.2%), raised SGPT in 41 (78.8%), thrombocytopenia in 46 (88.4%), leucopenia in 12 (23%) and leukocytosis in 11 (21.1%) patients. Common complication were hepatitis in 49 (94.2%), multi-organ dysfunction syndrome (MODS) in 12 (23.1%), acute respiratory distress syndrome (ARDS) and hypotension each in 10 (19.2%), meningoencephalitis in 5 (9.6%), acute kidney injury in 3 (5.8%), Hemophagocytic lymphohistiocytosis (HLH) and myocarditis in 1 (1.9%) patient each. Five patients died.
Conclusion: Scrub typhus should be considered in the differential diagnosis of acute febrile illness associated with gastrointestinal symptoms, hepatosplenomegaly and lymphadenopathy including those with organ dysfunctions such as hepatitis, thrombocytopenia, MODS, meningitis or ARDS. Empirical treatment for scrub typhus may be given in cases with strong clinical suspicion.

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