Pediatric scrub typhus in Southern Kerala: An emerging public health problem

BackgroundScrub typhus is a potentially fatal rickettsial infection endemic in Asia. But there are only very few reports of pediatric scrub typhus from Southern Kerala, which is situated in South India.ObjectiveTo study the clinicoepidemiological profile of pediatric patients with scrub typhus in Southern Kerala.MethodsClinical profile of 108 consecutive, 1- to 12-year-old children diagnosed with scrub typhus admitted in a tertiary care teaching hospital in South India from August 2011 to May 2015 was studied.ResultsThe median age of affected children was 6.83 years with a male to female ratio 1.42:1. Definite clustering of cases was noted from Nedumangaud Taluk, a hilly area in Trivandrum district (24%). A seasonal pattern was observed with a peak during the months of August–January (84.26%). Most common symptoms apart from fever were cough, abdominal pain, and vomiting. Most common signs were splenomegaly in 68.52% of cases and lymph node enlargement in 59.26% of cases. Eschar was present in 44.44% of cases, with the commonest site being inguinal region. Complications were seen in 9.25% of cases. Myocarditis was the most common complication and one case had associated coronary artery dilatation also. Case fatality rate was only 0.93%. Doxycycline and azithromycin were the antibiotics used. Fever subsided within 24 h of starting treatment in 73.15% of cases and within 48 h in 84.26% of cases.ConclusionScrub typhus is a common cause of fever in South India. Awareness among medical professional should be a high priority as late detection is the cause of failure of treatment, complications, and even mortality.