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Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity.
J Pediatric Infect Dis Soc. 2020 Apr 30; 9(2):202-209.JP

Abstract

BACKGROUND

Scrub typhus, caused by Orientia tsutsugamushi, is a major cause of acute febrile illness in children in the rural tropics.

METHODS

We recruited 60 febrile pediatric patients with a positive scrub typhus rapid diagnostic test result and 40 healthy controls from Chiang Rai Province in northern Thailand. Diagnosis was confirmed by the detection of (1) O. tsutsugamushi-specific DNA in blood or eschar samples with a polymerase chain reaction assay, (2) a fourfold rise in immunoglobulin M (IgM) titer to ≥1:3200 in paired plasma samples with an indirect immunofluorescence assay (IFA), or (3) a single IgM titer of ≥1:3200 in an acute plasma sample with an IFA. Demographic, clinical, and laboratory data were collected, and patients were followed up for 1 year.

RESULTS

Diagnosis was confirmed in 35 (58%) of 60 patients, and all controls tested negative for scrub typhus. Patients with confirmed scrub typhus had clinical symptoms, including fever (35 of 35 [100%]), eschar (21 of 35 [60%]), cough (21 of 35 [60%]), tachypnea (16 of 35 [46%]), lymphadenopathy (15 of 35 [43%]), and headache (14 of 35 [40%]). Only 4 (11%) of 35 patients received appropriate antibiotic treatment for scrub typhus before admission. The median fever-clearance time was 36 hours (interquartile range, 24-53 hours). Complications observed include hepatitis (9 of 35 [26%]), severe thrombocytopenia (7 of 35 [20%]), pneumonitis (5 of 35 [14%]), circulatory shock (4 of 35 [11%]), and acute respiratory distress syndrome (3 of 35 [9%]). Treatment failure, defined by failure to defervesce within 72 hours of antibiotic treatment initiation, was noted in 8 (23%) of 35 patients, and 1 (3%) of the 35 patients died. No evidence of relapse or reinfection was found.

CONCLUSION

Pediatric scrub typhus in northern Thailand is often severe and potentially fatal with delays in treatment a likely contributing factor. Additional studies to investigate the bacterial, pharmacologic, and immunologic factors related to treatment outcome along with measures to improve public awareness should be prioritized.

Authors+Show Affiliations

Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.Department of Pediatrics, Chiang Rai Prachanukroh Hospital, Thailand.Department of Family Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand.Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.Department of Medicine, Swiss Tropical and Public Health Institute and Faculty of Medicine, University of Basel, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30864670

Citation

Wangrangsimakul, Tri, et al. "Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity." Journal of the Pediatric Infectious Diseases Society, vol. 9, no. 2, 2020, pp. 202-209.
Wangrangsimakul T, Greer RC, Chanta C, et al. Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity. J Pediatric Infect Dis Soc. 2020;9(2):202-209.
Wangrangsimakul, T., Greer, R. C., Chanta, C., Nedsuwan, S., Blacksell, S. D., Day, N. P. J., & Paris, D. H. (2020). Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity. Journal of the Pediatric Infectious Diseases Society, 9(2), 202-209. https://doi.org/10.1093/jpids/piz014
Wangrangsimakul T, et al. Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity. J Pediatric Infect Dis Soc. 2020 Apr 30;9(2):202-209. PubMed PMID: 30864670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Characteristics and Outcome of Children Hospitalized With Scrub Typhus in an Area of Endemicity. AU - Wangrangsimakul,Tri, AU - Greer,Rachel C, AU - Chanta,Chulapong, AU - Nedsuwan,Supalert, AU - Blacksell,Stuart D, AU - Day,Nicholas P J, AU - Paris,Daniel H, PY - 2018/10/08/received PY - 2019/01/31/accepted PY - 2019/3/14/pubmed PY - 2019/3/14/medline PY - 2019/3/14/entrez KW - Orientia tsutsugamushi KW - Thailand KW - children KW - outcomes KW - scrub typhus SP - 202 EP - 209 JF - Journal of the Pediatric Infectious Diseases Society JO - J Pediatric Infect Dis Soc VL - 9 IS - 2 N2 - BACKGROUND: Scrub typhus, caused by Orientia tsutsugamushi, is a major cause of acute febrile illness in children in the rural tropics. METHODS: We recruited 60 febrile pediatric patients with a positive scrub typhus rapid diagnostic test result and 40 healthy controls from Chiang Rai Province in northern Thailand. Diagnosis was confirmed by the detection of (1) O. tsutsugamushi-specific DNA in blood or eschar samples with a polymerase chain reaction assay, (2) a fourfold rise in immunoglobulin M (IgM) titer to ≥1:3200 in paired plasma samples with an indirect immunofluorescence assay (IFA), or (3) a single IgM titer of ≥1:3200 in an acute plasma sample with an IFA. Demographic, clinical, and laboratory data were collected, and patients were followed up for 1 year. RESULTS: Diagnosis was confirmed in 35 (58%) of 60 patients, and all controls tested negative for scrub typhus. Patients with confirmed scrub typhus had clinical symptoms, including fever (35 of 35 [100%]), eschar (21 of 35 [60%]), cough (21 of 35 [60%]), tachypnea (16 of 35 [46%]), lymphadenopathy (15 of 35 [43%]), and headache (14 of 35 [40%]). Only 4 (11%) of 35 patients received appropriate antibiotic treatment for scrub typhus before admission. The median fever-clearance time was 36 hours (interquartile range, 24-53 hours). Complications observed include hepatitis (9 of 35 [26%]), severe thrombocytopenia (7 of 35 [20%]), pneumonitis (5 of 35 [14%]), circulatory shock (4 of 35 [11%]), and acute respiratory distress syndrome (3 of 35 [9%]). Treatment failure, defined by failure to defervesce within 72 hours of antibiotic treatment initiation, was noted in 8 (23%) of 35 patients, and 1 (3%) of the 35 patients died. No evidence of relapse or reinfection was found. CONCLUSION: Pediatric scrub typhus in northern Thailand is often severe and potentially fatal with delays in treatment a likely contributing factor. Additional studies to investigate the bacterial, pharmacologic, and immunologic factors related to treatment outcome along with measures to improve public awareness should be prioritized. SN - 2048-7207 UR - https://www.unboundmedicine.com/medline/citation/30864670/Clinical_Characteristics_and_Outcome_of_Children_Hospitalized_With_Scrub_Typhus_in_an_Area_of_Endemicity_ L2 - https://academic.oup.com/jpids/article-lookup/doi/10.1093/jpids/piz014 DB - PRIME DP - Unbound Medicine ER -