Clinical Profile and Outcome of Children with Scrub typhus: A Tertiary Care Centre Observation.

Abstract

Objective: Scrub typhus is an acute febrile illness and often can present with multi-organ dysfunction. The primary objective of the study was to find out its clinical presentation and associated complications and secondary objectives for the response to therapy in relation to severity of disease and observe the mortality.

Methods: This was a prospective observational study conducted in children, aged 1 - 18 years, with diagnosis of scrub typhus at a tertiary -care center. The diagnosis of Scrub typhus was based on compatible clinical presentation and positive specific IgM antibody titer.

Results: Seventy children with scrub typhus (males 67.1%), median age of 9 years (interquartile range 5 - 13) presented with fever (100%), abdominal pain (54.2%), vomiting (38.6%), cough (32.8%), and rash (22.8%). On examination, hepatomegaly (67.1%), pallor (61.4%), conjunctival congestion (60%) and splenomegaly (52.8%) were the predominant features. Nearly half of cases had fluid retention (45.7%), with respiratory distress (38.5%), myocarditis (31.4%), secondary hemophagocytic lymphohistiocytosis (28.6%), shock (25.7%), acute kidney injury (18.6%), and encephalitis (18.6%). Parenteral doxycycline was given along with supportive measures such as oxygen therapy, respiratory support, diuretic, and vasopressors. Patients having three or four of severe manifestations (fluid retention, myocarditis, shock and hemophagocytic lymphohistiocytos) had almost 17 - 18 times probability of late response to doxycycline in contrast to those who had two severe features (nearly 14 times, P = 0.001). Mortality was in 4.3% of cases.

Conclusion: Scrub typhus is a serious infection presenting with multi-system involvement. Prompt therapy with Doxycycline along with supportive therapy help in better outcome.