Clinicolaboratory Profile and Outcome of Serologically Confirmed Scrub Typhus among Children from Sub Himalayan Tribal District of India: A Hospital-based Cross-sectional Study
Introduction: Scrub typhus is transmitted by the bite of the larva (chigger) of a microscopic trombiculidae mite (Leptotrombidium) found in moist areas and vegetation, which serves as both vector and reservoir. Scrub typhus is an often neglected and misdiagnosed febrile illness; clinical suspici...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2022-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/16778/57061_CE(AD)_F(SHU)_PF1(SC_KM)_PFA(SC_KM)_PN(KM).pdf |
| Summary: | Introduction: Scrub typhus is transmitted by the bite of the larva
(chigger) of a microscopic trombiculidae mite (Leptotrombidium)
found in moist areas and vegetation, which serves as both
vector and reservoir. Scrub typhus is an often neglected and
misdiagnosed febrile illness; clinical suspicion is the only key
to diagnosis.
Aim: To study clinicolaboratory profile and outcome of serologically
confirmed scrub typhus in children from sub Himalayan tribal district
of India.
Materials and Methods: This cross-sectional observational study
was conducted in Department of Paediatrics at Government
District Hospital, Chamba, Himachal Pradesh, India, from May
2019 to April 2020. Children upto 18 years admitted with positive
Immunoglobulin M (IgM) antibodies for scrub typhus were enrolled.
The observational data including detail history and examination,
relevant laboratory investigation and treatment was analysed by
Statistical Package for Social Sciences (SPSS) software version
18.0 and Chi-square test with p-value <0.05 was considered
statistically significant.
Results: There were total 55 patients with scrub typhus, mean
age was 9.2 years, most common age group was 7-12 years,
51% were male. Fever was most common complaint, followed
by vomiting (27.3%), abdomen pain (25.4%), respiratory (1.8%),
and rash (9%). Clinical examination findings were generalised
lymphadenopathy in 46 (83.6%) patients and splenomegaly in
29 (52.7%). Eight patients presented with respiratory signs and
tachypnea at the time of admission. Eschar was present in only
3 (5.5%) patients. Sign of meningeal irritation was present in
4 (7.3% cases and low GCS score (below 9) was observed in
7 (12.7%) patients. Eight patients required mechanical ventilatory
support. Nineteen patients were prescribed doxycycline alone;
while 34 were given both azithromycin and doxycycline. There
were total five deaths; on multivariate logistic regression,
respiratory complaint, need for mechanical ventilation, pain
abdomen with liver damage, history of seizures and duration of
fever more than four days before presentation to hospital were
associated with adverse outcome.
Conclusion: The prevalence of scrub typhus is considerably
high during rainy season, and should be considered as a
differential diagnosis of fever among children in this period
regardless of the presence of an eschar. Immediate medical
care, treatment with doxycycline with early defervescence of
fever reduce mortality. |
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| ISSN: | 2249-782X 0973-709X |