A study on scrub typhus in children: Experience in a tertiary care hospital

Abstract

Objective: To study the epidemiological profile, clinical presentation, laboratory markers, treatment outcomes, complications and prognosis of scrub typhus among children presenting to this tertiary care hospital. Method: A cross sectional study was carried out in a tertiary care paediatric hospital between May 2015 and April 2016 on children between 1 month and 12 years who presented with fever and various clinical features suggestive of rickettsial infections. They were included as a convenience sample and tested for scrub typhus by Weil-Felix test as well as IgM ELISA. Children testing positive for scrub typhus were recruited for further study and observed for the various outcome measures. Results: There were 136 children between 1 month and 12 years presenting with fever and clinical features suggestive of rickettsial infections during the study period. Of these, 46 children tested positive for scrub typhus and were included in the study. No patient refused to participate or withdrew from the study. The mean age of the children was 5.5 years, 61% were male, 91% had rural habitats and admissions peaked between August and December. Mean duration of fever before presentation was 10.3 days. Fever (100%), oedema (45.6%), irritability (45.6%), abdominal pain (39.1%), conjunctival congestion (36.9%), vomiting (34.8%), maculopapular rash (32.6%), headache (21.7%), altered sensorium (17.4%), cough (15.2%), eschar (13%) and seizure (10.8%) were the main symptoms. Lymphadenopathy (73.9%), hepatomegaly (71.7%) and splenomegaly (52.1%) were the main signs. Elevated C-reactive protein (100%), anaemia (78.3%), hyponatraemia (73.9%), hypoalbuminaemia (65.2%), leucocytosis (56.5%), transaminitis (32.6%) and thrombocytopenia (17.4%) were important laboratory features. All were IgM ELISA positive and 42 were Weil-Felix test positive. Fever subsided between 24 to 48 hours in the majority. Doxycycline and azithromycin showed similar efficacy. There was no mortality. Conclusion: Scrub typhus is prevalent among children presenting to this tertiary care hospital in Kolkata, India. Sri Lanka Journal of Child Health, 2019; 48(2): 155-159