Scrub Typhus in Children at a Tertiary Hospital in North India: Clinical Profile and Complications

Nowneet  Kumar Bhat; Minakshi  Dhar; Garima  Mittal; Nadia  Shirazi; Anil  Rawat; Bram  Prakash Kalra; Vipan  Chandar; Sohaib  Ahmad

IJ Pediatrics

The Scientific Journal of Growth & Development Research Center

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Scrub Typhus in Children at a Tertiary Hospital in North India: Clinical Profile and Complications

Author(s):

Nowneet Kumar Bhat^1,*,

Minakshi Dhar²,

Garima Mittal³,

Nadia Shirazi⁴,

Anil Rawat⁵,

Bram Prakash Kalra⁶,

Vipan Chandar⁷,

Sohaib Ahmad⁸

IJ Pediatrics:Vol. 24, issue 4; 387-392

Published online:Jul 19, 2014

Article type:Research Article

Received:Sep 16, 2013

Accepted:Apr 13, 2014

How to Cite:Nowneet Kumar BhatMinakshi DharGarima MittalNadia ShiraziAnil RawatBram Prakash KalraVipan ChandarSohaib Ahmadet al.Scrub Typhus in Children at a Tertiary Hospital in North India: Clinical Profile and Complications.Iran J Pediatr.24(4):387-392.

Abstract

Objective: To study the clinical profile and complications of childhood scrub typhus.Methods: Prospective observational study of 66 children with scrub typhus, admitted to a tertiary hospital in north India, during the period between January 2011 and December 2012. The diagnosis was confirmed by serology.Findings: 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. Meningoencephalitis (30.3%), severe thrombocytopenia (27.2%), shock (25.8%), acute kidney injury (16.7%) and hepatitis (13.6%) were the most common complications observed in these children. Other common complications were acute respiratory distress syndrome, respiratory failure requiring ventilation, bronchopneumonia and myocarditis. Ninety percent of children became afebrile within 48 hours of initiating an appropriate antibiotic. Median time to defervescence was 22 hours. The overall mortality rate was 7.5%. Causes of death were refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute kidney injury and myocarditis.Conclusion: Pediatricians should keep a high index of suspicion for scrub typhus in any febrile child having a maculopapular rash, hepatosplenomegaly, tender lymphadenopathy, thrombocytopenia and features suggestive of capillary leak. Pending serological confirmation, empirical therapy with doxycycline or azithromycin should be started, as delay in treatment would result in life threatening complications.

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