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Clinico - Laboratory Profile of Scrub Typhus - An Emerging Rickettsiosis in India.
Indian J Pediatr. 2016 Nov; 83(12-13):1392-1397.IJ

Abstract

OBJECTIVE

To study the clinical and laboratory profile of pediatric scrub typhus in rural south India.

METHODS

This is a descriptive study of the clinical and laboratory features of 117 children with IgM ELISA proven scrub typhus out of 448 children, who were admitted in the Pediatric ward of a tertiary care hospital, during the study period of November 2014 through March 2015.

RESULTS

Fever was present in all 117 children, with mean duration of fever at admission as 9 d. Gastrointestinal tract was the most commonly affected system, seen in 51 % of children. Cough (82 %), myalgia (70 %), vomiting (68 %), headache (45 %) and pain abdomen (42 %) were the most common symptoms of scrub typhus. Hepatomegaly (70), splenomegaly (53 %), pallor (50 %) and eschar (41 %) were the common clinical findings in children with scrub typhus. Out of 49 children with eschar, 32 were associated with regional lymphadenopathy, which was commonly seen in axillary, neck and groin regions. Leucocytosis (50 %), anemia (56 %), increased SGOT / SGPT (47 %), thrombocytopenia (41 %), hypoalbuminemia (40 %) and hyponatremia (40 %) were the common lab features. Shock (46 %), myocarditis (24 %) and pneumonia (16 %) were the common complications seen in these children. This study showed that early treatment for scrub typhus results in a good outcome in terms of early recovery and nil mortality.

CONCLUSIONS

Regional lymphadenopathy is a marker of hidden or developing eschar. Total count and differential count should be interpreted on the background of the duration of fever. Since IgM ELISA, which is diagnostic of scrub typhus may not be widely available, any febrile child coming from rural area with hepatosplenomegaly, pallor, eschar, generalised / regional lymphadenopathy, anemia, leucocytosis, thrombocytopenia and increased Aspartate transaminase (AST) /Alanine aminotransferase (ALT) should be started on empirical Doxycycline or Azithromycin in order to prevent life threatening complications secondary to delay in therapy.

Authors+Show Affiliations

Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India. dinesh.paed@gmail.com.Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India.Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India.Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27352842

Citation

Narayanasamy, Dinesh Kumar, et al. "Clinico - Laboratory Profile of Scrub Typhus - an Emerging Rickettsiosis in India." Indian Journal of Pediatrics, vol. 83, no. 12-13, 2016, pp. 1392-1397.
Narayanasamy DK, Arunagirinathan AK, Kumar RK, et al. Clinico - Laboratory Profile of Scrub Typhus - An Emerging Rickettsiosis in India. Indian J Pediatr. 2016;83(12-13):1392-1397.
Narayanasamy, D. K., Arunagirinathan, A. K., Kumar, R. K., & Raghavendran, V. D. (2016). Clinico - Laboratory Profile of Scrub Typhus - An Emerging Rickettsiosis in India. Indian Journal of Pediatrics, 83(12-13), 1392-1397. https://doi.org/10.1007/s12098-016-2171-6
Narayanasamy DK, et al. Clinico - Laboratory Profile of Scrub Typhus - an Emerging Rickettsiosis in India. Indian J Pediatr. 2016;83(12-13):1392-1397. PubMed PMID: 27352842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinico - Laboratory Profile of Scrub Typhus - An Emerging Rickettsiosis in India. AU - Narayanasamy,Dinesh Kumar, AU - Arunagirinathan,Arul Kumaran, AU - Kumar,Revathi Krishna, AU - Raghavendran,V D, Y1 - 2016/06/29/ PY - 2015/08/31/received PY - 2016/05/30/accepted PY - 2016/6/30/pubmed PY - 2018/3/17/medline PY - 2016/6/30/entrez KW - Eschar KW - Leucocytosis KW - Lymphadenopathy KW - Rickettsial fever KW - Scrub typhus SP - 1392 EP - 1397 JF - Indian journal of pediatrics JO - Indian J Pediatr VL - 83 IS - 12-13 N2 - OBJECTIVE: To study the clinical and laboratory profile of pediatric scrub typhus in rural south India. METHODS: This is a descriptive study of the clinical and laboratory features of 117 children with IgM ELISA proven scrub typhus out of 448 children, who were admitted in the Pediatric ward of a tertiary care hospital, during the study period of November 2014 through March 2015. RESULTS: Fever was present in all 117 children, with mean duration of fever at admission as 9 d. Gastrointestinal tract was the most commonly affected system, seen in 51 % of children. Cough (82 %), myalgia (70 %), vomiting (68 %), headache (45 %) and pain abdomen (42 %) were the most common symptoms of scrub typhus. Hepatomegaly (70), splenomegaly (53 %), pallor (50 %) and eschar (41 %) were the common clinical findings in children with scrub typhus. Out of 49 children with eschar, 32 were associated with regional lymphadenopathy, which was commonly seen in axillary, neck and groin regions. Leucocytosis (50 %), anemia (56 %), increased SGOT / SGPT (47 %), thrombocytopenia (41 %), hypoalbuminemia (40 %) and hyponatremia (40 %) were the common lab features. Shock (46 %), myocarditis (24 %) and pneumonia (16 %) were the common complications seen in these children. This study showed that early treatment for scrub typhus results in a good outcome in terms of early recovery and nil mortality. CONCLUSIONS: Regional lymphadenopathy is a marker of hidden or developing eschar. Total count and differential count should be interpreted on the background of the duration of fever. Since IgM ELISA, which is diagnostic of scrub typhus may not be widely available, any febrile child coming from rural area with hepatosplenomegaly, pallor, eschar, generalised / regional lymphadenopathy, anemia, leucocytosis, thrombocytopenia and increased Aspartate transaminase (AST) /Alanine aminotransferase (ALT) should be started on empirical Doxycycline or Azithromycin in order to prevent life threatening complications secondary to delay in therapy. SN - 0973-7693 UR - https://www.unboundmedicine.com/medline/citation/27352842/Clinico___Laboratory_Profile_of_Scrub_Typhus___An_Emerging_Rickettsiosis_in_India_ L2 - https://dx.doi.org/10.1007/s12098-016-2171-6 DB - PRIME DP - Unbound Medicine ER -