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Scrub typhus in rural Rajasthan and a review of other Indian studies.
Paediatr Int Child Health. 2016 May; 36(2):148-53.PI

Abstract

BACKGROUND

Scrub typhus is an acute febrile illness which has been reported from various parts of India with Rajasthan recently joining the list of affected states.

AIM

To report a series of paediatric scrub typhus cases from rural Rajasthan.

STUDY DESIGN

Retrospective review of children with scrub typhus admitted to the wards and paediatric intensive care unit (PICU) of a tertiary-care hospital.

METHODS

The study was undertaken over an 8-month period from May to December 2013. All patients with a clinical presentation and/or serological confirmation of scrub typhus who tested negative for malaria, enteric fever, dengue, leptospirosis and urinary tract infection (UTI) were included. A range of investigations were undertaken including IgM-ELISA for scrub typhus, followed by appropriate medical management.

RESULTS

Thirty patients satisfied the inclusion criteria. The mean (SD, range) age of the patients was 8·56 (3·43, 3-16) years. The most common clinical features were fever (n = 30, 100%), headache (n = 20, 66%), myalgia (n = 15, 50%), hepatosplenomegaly (n = 18, 60%) and pallor (n = 5, 16%). Typical features such as eschar and rash were observed in only one (3·3%) and three (10%) patients, respectively; none had generalised lymphadenopathy or conjunctival congestion. IgM-ELISA for scrub typhus was positive in 28 patients (93·3%) and 27 responded to doxycycline within 24-72 hours. One of the three patients who required PICU support responded to intravenous chloramphenicol and, of the other two (6·6%), one died of acute respiratory distress syndrome and the other owing to acute renal failure.

CONCLUSION

A high index of suspicion is essential for early diagnosis and prevention of complications in scrub typhus together with prompt referral from rural areas to a higher centre. Awareness of the disease manifestations may further help to prevent excessive investigations in patients presenting with non-specific febrile illness and reduce the economic burden to the family and society in resource-constrained settings.

Authors+Show Affiliations

a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25704650

Citation

Masand, Rupesh, et al. "Scrub Typhus in Rural Rajasthan and a Review of Other Indian Studies." Paediatrics and International Child Health, vol. 36, no. 2, 2016, pp. 148-53.
Masand R, Yadav R, Purohit A, et al. Scrub typhus in rural Rajasthan and a review of other Indian studies. Paediatr Int Child Health. 2016;36(2):148-53.
Masand, R., Yadav, R., Purohit, A., & Tomar, B. S. (2016). Scrub typhus in rural Rajasthan and a review of other Indian studies. Paediatrics and International Child Health, 36(2), 148-53. https://doi.org/10.1179/2046905515Y.0000000004
Masand R, et al. Scrub Typhus in Rural Rajasthan and a Review of Other Indian Studies. Paediatr Int Child Health. 2016;36(2):148-53. PubMed PMID: 25704650.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scrub typhus in rural Rajasthan and a review of other Indian studies. AU - Masand,Rupesh, AU - Yadav,Ritesh, AU - Purohit,Alok, AU - Tomar,Balvir Singh, PY - 2015/2/24/entrez PY - 2015/2/24/pubmed PY - 2017/2/1/medline KW - Children KW - India KW - Rural KW - Scrub typhus SP - 148 EP - 53 JF - Paediatrics and international child health JO - Paediatr Int Child Health VL - 36 IS - 2 N2 - BACKGROUND: Scrub typhus is an acute febrile illness which has been reported from various parts of India with Rajasthan recently joining the list of affected states. AIM: To report a series of paediatric scrub typhus cases from rural Rajasthan. STUDY DESIGN: Retrospective review of children with scrub typhus admitted to the wards and paediatric intensive care unit (PICU) of a tertiary-care hospital. METHODS: The study was undertaken over an 8-month period from May to December 2013. All patients with a clinical presentation and/or serological confirmation of scrub typhus who tested negative for malaria, enteric fever, dengue, leptospirosis and urinary tract infection (UTI) were included. A range of investigations were undertaken including IgM-ELISA for scrub typhus, followed by appropriate medical management. RESULTS: Thirty patients satisfied the inclusion criteria. The mean (SD, range) age of the patients was 8·56 (3·43, 3-16) years. The most common clinical features were fever (n = 30, 100%), headache (n = 20, 66%), myalgia (n = 15, 50%), hepatosplenomegaly (n = 18, 60%) and pallor (n = 5, 16%). Typical features such as eschar and rash were observed in only one (3·3%) and three (10%) patients, respectively; none had generalised lymphadenopathy or conjunctival congestion. IgM-ELISA for scrub typhus was positive in 28 patients (93·3%) and 27 responded to doxycycline within 24-72 hours. One of the three patients who required PICU support responded to intravenous chloramphenicol and, of the other two (6·6%), one died of acute respiratory distress syndrome and the other owing to acute renal failure. CONCLUSION: A high index of suspicion is essential for early diagnosis and prevention of complications in scrub typhus together with prompt referral from rural areas to a higher centre. Awareness of the disease manifestations may further help to prevent excessive investigations in patients presenting with non-specific febrile illness and reduce the economic burden to the family and society in resource-constrained settings. SN - 2046-9055 UR - https://www.unboundmedicine.com/medline/citation/25704650/Scrub_typhus_in_rural_Rajasthan_and_a_review_of_other_Indian_studies_ L2 - https://www.tandfonline.com/doi/full/10.1179/2046905515Y.0000000004 DB - PRIME DP - Unbound Medicine ER -