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Clinical profile of Scrub typhus in Pediatric population –A case series 10/27/2014 00:00:00

Clinical profile of Scrub typhus in Pediatric population –A case series

Antony J Jenifer, Francine L Shirley, Nathan R, Suresh P, Rathinasamy M, Abdul Mallik.
Department of Pediatrics, Chetinad Medical College hospital and Research Institute, Chennai, India.

Dr Antony Jenifer, Department of Pediatrics, Chetinad Medical College hospital & Research Institute, Chennai 603103
Scrub typhus, transmitted by the bite of larval trombiculid mite is a common and an underdiagnosed cause of febrile illness in south Asia, caused by infection with Orientia tsutsugamushi. Outbreaks are reported during cooler months of year. (1)While visiting forests infection is transmitted from rodents to human by the bite of larval stage Leptotrombidium mites (chiggers). Inoculation of the organism at a cutaneous mite bite site causes localized pathological skin reaction termed an eschar. The characteristic rash and eschar may not be always present. The common symptoms described include fever, severe headache, myalgia, dry cough and gastrointestinal disturbances. (2) However, combination of systems involved can vary. Common signs described from children include eschar at the site of bite, maculopapular rash, lymphadenopathy and hepatosplenomegaly. In cases of fever of unknown origin, once the common causes like malaria, typhoid, dengue, leptospirosis, septicemia are ruled out and after one course of anti-malarials, scrub typhus has to be suspected, even though there is no history of visiting forests. Routine laboratory tests may reveal anemia and thrombocytopenia; elevated transaminases and hypoalbuminemia can be used as pointer to investigate for rickettsial diseases. An early diagnosis and treatment can prevent complications. In resource poor countries, initial Weil Felix test followed by ELISA (4) based test for O. tsutsugamushi can make proper diagnosis. Although indirect immunofluorescence assay (IFA) or Indirect Immuno-peroxidase test (IIP) and polymerase chain reaction (PCR) based tests are considered gold standard in confirmation of rickettsial diseases (5), they can only be performed in sophisticated laboratories

In our series, detailed results of 5 cases are shown in table 1. All had anemia and eschar, 2 children had mild hepatosplenomegaly and 2 had thrombocytopenia. All were positive for IgM for scrub typhus. The 8 year old child was given doxycycline and younger ones were given azithromycin. In all, fever subsided in 2 days and all recovered. Out of five cases, 3 children had history of travel to hilly area which predisposes them to chigger bite.

Table 1: Clinical Profile of Pediatric Scrub Typhus
  Case 1 Case 2 Case 3 Case 4 Case 5
Age/Sex 2years/Male 1 ½ yrs/ Male 2 ¼ years /Male 7 months/Male 8years/Male
Chief complaints Fever -5 days, Vomiting Fever-1 week Fever-3days, Vomiting Fever-4days Fever-6 days, vomiting
History of insect bite No No No No No
Pallor yes yes No yes yes
Edema No No No No No
Eschar Over right nape of neck Over right shoulder Right axilla Back of right thigh Left axilla
Hepatomegaly yes yes yes yes yes
Splenomegaly yes yes No yes No
Respiratory symptoms Conducted sounds Wheeze NVBS NVBS NVBS
CNS symptoms No yes No No No
Hemoglobin (gm/dl) 9.6 8.9 10.7 8.1 8.2
Platelet (cells/cumm) 1,81,000 2,03,000 1,57,000 1,36,000 1,01,000
IgM for scrub typhus Reactive Reactive Reactive Reactive Reactive
Treatment/ Outcome azithromycin azithromycin azithromycin azithromycin doxycycline

Compliance with Ethical Standards
Funding None
Conflict of Interest None
  1. Mathai E, Rolain JM , Varghese GM, Abraham OC, Mathai D, Raoult D. Outbreak of scrub typhus in Southern India during the cooler months. Ann N Y Acad Sci. 2003; 990: 359-364  [CrossRef]
  2. Kovacova E, Kazar J. Rickettsial diseases and their serological diagnosis. Clin Lab. 2000; 46: 239-245.  [PubMed]
  3. Mathai E, Lloyd G, Cherian T, Abraham OC, Cherian AM. Serological evidence of continued presence of human Rickettsiosis in southern India. Ann Trop Med Parasitol. 2001;95:395-398.  [CrossRef]
  4. Sundhindra BK, Vijaykumar S, Kutti AK. Rickettsial spotted fevers in Kerala. Natl Med J India. 2004;17:51-52.  [PubMed]
  5. Bhattacharya D, Mittal V, Bhatia R, Sehgal S, Passey MN. Comparison between indirect fluorescent antibody and Weil-Felix tests for detecting antibodies against rickettsia. J Commun Dis 1991; 23: 144-148.  [PubMed]


Cite this article as:
Jenifer A J, Shirley F L, R N, P S, M R, Mallik A. Clinical profile of Scrub typhus in Pediatric population - A case series. Pediatr Oncall J. 2015;12: 21-22. doi: 10.7199/ped.oncall.2015.7
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