Clinical profile and outcome of children with scrub typhus from Chennai, South India

• DOI: 10.1007/s00431-018-3143-9
• Publication Date: 2018-04-10T14:38:32Z
• Authors: Ramaswamy Ganesh; Natarajan Suresh; L. L. Pratyusha; Lalitha Janakiraman; Mani Manickam; A. Andal
• Keywords: Male; Adolescent; Infant, Newborn; India; Infant; Azithromycin; Anti-Bacterial Agents; 3. Good health; 03 medical and health sciences; Chloramphenicol; Logistic Models; Treatment Outcome; 0302 clinical medicine; Scrub Typhus; Child, Preschool; Doxycycline; Humans; Drug Therapy, Combination; Female; Prospective Studies; Child

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. We prospectively studied the clinico-laboratory profile and outcome of 358 children aged 1 day to 18 years diagnosed with scrub typhus from Chennai, South India. All children (100%) had fever. Eschar was seen in 67%. All children were treated with oral doxycycline and those with complications were treated with intravenous chloramphenicol/azithromycin. Rapid defervescence (within 48 h) after initiation of doxycline was seen in 306 (85%) and 52 (14.5%) developed complications. Multivariate logistic regression analysis revealed that children who had an elevated aspartate amino transferase (> 120 IU/L) and the presence of thrombocytopenia (platelet count less than 1 lac cells/mm3) at admission had high risk of developing complications. The overall mortality rate in this series was 0.8%.Our 4-year study highlights the clinico-laboratory profile of Scrub typhus in children from Chennai, South India. Early recognition and prompt treatment reduces the complication and mortality. What is Known: • Scrub typhus is endemic to tsutsugamushi triangle, a geographical triangle extending from northern Japan in the east to Pakistan and Afghanistan in the west and northern Australia in the south. • There is paucity of data regarding its clinico-laboratory profile in neonates as well as its predictors of outcome. What is New: • Children who had an elevated AST and the presence of thrombocytopenia at admission had high risk of developing complications.