Prevalence, clinico-laboratory features and outcome of paediatric scrub typhus cases in a tertiary care centre in Eastern India: A prospective observational study

Abstract

Objective: Scrub typhus is the most common rickettsial disease in India, caused by Orientia tsutsugamushi, and transmitted by chigger mites. Previously reported in South India, but the resurgence of cases is currently reported in Eastern India. This study aimed to estimate the prevalence and describe the clinico-laboratory profile of scrub typhus in paediatric patients (1-12 years old) in Eastern India. Methods: A prospective observational study was conducted from January to December 2019 in a paediatric tertiary care centre in Kolkata. All acute undifferentiated febrile illness cases (1-12 years) were tested for scrub typhus serology by ELISA. Demographic details, clinical features, laboratory findings, complications and treatment outcomes of scrub typhus patients were extracted in Microsoft Excel spreadsheet and further analysed. Results: The prevalence of scrub typhus among acute febrile illness patients was 4.5 %. The mean age of patients was 5.22 years and the majority (64.2 %) had a fever for the last 7-14 days. Gastrointestinal symptoms like vomiting (43.3 %) and pain abdominal (32.8 %) were frequently seen. Major clinical signs were hepatomegaly (41.8 %) and splenomegaly (31.3 %). Complication was observed in 74.6 %, with thrombocytopenia (40.3 %) and meningoencephalitis (29.9 %) being more frequent. The case fatality rate was 1.5 %. Conclusions: Classical eschar was absent in three-fourth of our patients, hence we advocate laboratory scrub typhus testing for all suspected cases in endemic region. Thrombocytopenia and meningoencephalitis were prominent complications in our study. Prompt treatment with doxycycline and/or azithromycin could prevent complications and reduce mortality.

Keywords: Hospital Stay; Hospitalization, patient discharge; General Internal Medicine