Rickettsial disease — An Experience

Objective: To determine the prevalence, clinical pattern and complications of Rickettsial disease at a tertiary hospital in Maharashtra.Material and methods: The present study comprises of 156 cases admitted in paediatric intensive care unit. Ashwini Sahakari Rughnalaya and Research Center, Solapur, Maharashtra,. Between the period from January 2006 to December 2008.Selection Criteria: All paediatric patients who were suspected clinically of rickettsial infection were included in the study. Majority of them tested positive for Weil-Felix test. Clinical suspicion of rickettsial fever was based on the history of fever, non-confluent maculopapular rash or purpuric rash involving palms and soles. Data regarding age, sex. residential area, exposure to animals, tick bite, exposure to farming was collected in each case. Each patient was subjected to a battery of investigations, which include CBC, test for malarial parasite, widal test and detection of dengue IgM antibodies and leptospira in a few. These investigations were done to rule out other common disorders which have similar presentation. Other investigation like CSF examination, serum electrolytes, SGPT. blood culture were done as per requirement of the case. Immunofluorescent Assay, which is gold standard investigation, was done in 2 cases. ELISA for spotted fever was done in 26 cases. The suspected cases where treated with Chloramphenicol (50 100 mg/kg/day) and Doxycycline (3-5mg /kg /day) for 7 to 10 days and supportive care as per the need. The response to treatment and prognosis was noted in all cases. Results: The present study included 156 cases, which accounts for 12% of admissions in pediatric intensive care unit. Age at which these patients presented varied from 6 months to 13 years. Fever and rash were the most common symptoms where as altered sensorium. hepatosplenomegaly and rash were the most common signs. Among complications, encephalitis (71.79%) and necrotic rash (50.62%) were the most common. Other complications like ARDS, myocarditis, DIC. renal failure were also encountered. Out of 156 cases, 124 patients (79.48%) recovered with standard anti-rickettsial and supportive treatment while 18 of these died(11.53%).