DOI: 10.36347/sjams.2016.v04i10.032

Pages: 3714-3720

Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that causes a generalized vasculitis that may involve the tissues of any organ system. It is a re-emerging disease affecting many parts of India. We undertook a descriptive study to identify the clinical and laboratory features associated with severe scrub typhus in children. All children up to 18 years of age who presented with severe scrub typhus to the Pediatric Department of Nazareth Hospital between January 2014 and December 2014. A total of 75 cases were included. Results showed that the symptoms of severe scrub typhus were fever (100%), headache (58.7%), loss of appetite (46.7%) and cough (46.7%), vomiting (45.3%), abdominal pain (32%), breathing difficulty (25.3%), myalgia (24%) and altered sensorium (24%). Conjunctival redness was present in 44% of patients, pallor in 28% and eschar in 21%. Meningoencephalitis was seen in 58.6%. Pneumonia was the commonest respiratory complication seen in 24% cases. Hypotension and shock was found in 16% of patients. A MODS was seen in 42.6% cases. Laboratory findings were raised acute phase reactants, hypoalbuminemia, anaemia and hypocalcemia. There was only 1 death. Our findings suggest that the severe form of scrub typhus is very common and clinicians should have a high index of suspicion for severe scrub typhus when children present with fever, headache, conjunctival redness and eschar in an area endemic to scrub typhus. Identification of clinical signs like neck stiffness, low blood pressure and respiratory distress would help in timely recognition of complications such as meningoencephalitis, shock and pneumonia. Frequent monitoring of blood haemoglobin, platelet count, and serum albumin and serum calcium levels is warranted. Early intervention can significantly reduce morbidity and mortality.