Clinical and laboratory profile of pediatric scrub typhus in a tertiary care teaching hospital in Southern India

Abstract

Background: Scrub typhus is a common aetiology for an acute undifferentiated fever among children. Early recognition and prompt management help to reduce morbidity and mortality.Methods: All children who visited our pediatric out-patient department between January 2016 and February 2018, admitted with clinical suspicion of scrub typhus and having positive serum IgM by ELISA were included in the study.Results: A total of 83 cases were enrolled during the study period. Of these 55 were boys and 28 girls. The average age of presentation was seven years, and the youngest was just five months old. Majority of these patients were from rural areas (86%). Roughly, two-thirds (77%) of the study group practiced open defecation. A maximum number of cases (65;78.3%) were reported during monsoon season (between September and January).Prolonged fever (100%), gastrointestinal symptoms (76%) such as vomiting, diarrhoea and abdominal pain, lymphadenopathy (96%) and hepatosplenomegaly (61%) were common signs and symptoms of pediatric scrub typhus. Only six patients had severe illnesses. The diagnosis was based on the positive serum IgM for scrub typhus. All the patients were IgM positive. Out of these 83 patients, eschar was seen in 50 (60%) patients. Weil Felix test was positive in 15 cases out of 33 tested cases. Six children had co-infection with 2 cases of malaria and four dengue fever cases.Conclusions: Scrub typhus is one of the common causes for acute undifferentiated fever among children. A high index of clinical suspicion and a lookout for an eschar shall facilitate an early diagnosis of scrub typhus.