Scrub typhus: An uncommon cause of pyrexia without focus

Abstract

Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi. Commonly reported from hilly and forest areas, it usually presents with fever, eschar, maculopapular rash, headache, gastrointestinal symptoms and lymphadenopathy We report a seven year old male resident of Delhi, a non-endemic region, presenting with pyrexia without focus and fluid refractory hypotension, subsequently diagnosed as scrub typhus. Fever responded to doxycycline and child was discharged on day 5. To conclude, rickettsial infections can be seen in non-endemic, urban areas as well and should be suspected and investigated in children presenting with pyrexia without focus, not responding to usual antibiotics.