Clinical Profile of Scrub Typhus among Paediatric Age Group in a Tertiary Care Center

Abstract

Introduction: Scrub typhus, a dreaded disease in the pre-antibiotic era, was a serious military disease that killed thousands of people in the Far East during WWII. It is a zoonosis that is common throughout Asia and the Pacific Islands. Scrub typhus is a febrile illness characterized by a wide range of symptoms and indications. This disease has a wide spectrum of clinical symptoms, from subclinical through organ failure to death. The objective of this study was to assess the clinical profile of scrub typhus infection among children in a tertiary care hospital in south India. Methodology: This is a retrospective study of the clinical profile of 50 paedriatric children, who were admitted in the Paediatric ward of a tertiary care hospital, during the study period of JAN 2020 to DEC 2020. Results: All children presented with fever. Other common symptoms were vomiting (56%), facial swelling (52%), cough (35%), abdominal pain (33%), breathlessness (29%) and decreased urine output (29%). High grade fever (>101 oF) was recorded in 91% of children. Other common signs were hepatomegaly, splenomegaly, edema, tender lymphadenopathy and hypotension, observed in 82%, 59%, 39%, 38% and 36% of cases, respectively. An eschar and a maculopapular rash each were observed in 20% of patients. Within 48 hours of starting an appropriate antibiotic, 90% of the children became afebrile. Overall, there was a 7.5 percent mortality rate. Refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute renal damage, and myocarditis were among the causes of mortality. Conclusion: In any febrile child with a maculopapular rash, hepatosplenomegaly, tender lymphadenopathy, thrombocytopenia, or symptoms indicative of capillary leak, paediatricians should have a high index of suspicion for scrub typhus. Pending serological confirmation, empirical therapy with doxycycline or azithromycin should be initiated immediately, since any delay in treatment could lead to life-threatening consequences.