Scrub typhus in children at a tertiary hospital in southern India: Clinical profile and complications

SummaryObjectiveTo study the clinical profile of and complications in children with scrub typhus.DesignProspective observational study.SettingTertiary care hospital.MethodsChildren up to 12 years of age who had a fever for more than five days without an identifiable infection were included. All children who were suspected of having rickettsial infections were defined as having scrub typhus if they had a positive Weil-Felix test result (OX-K 1:80 or more) and one or more of the following clinical features (after exclusion of other diagnoses): rash, edema, hepatosplenomegaly, lymphadenopathy, an eschar, and a tick bite or tick exposure.ResultsThirty-five children were diagnosed with scrub typhus between February 2010 and February 2011. The age of the patients ranged from 1.5 to 12 years. Edema, crackles/rhonchi, hepatomegaly and hypotension were encountered in 60%, 23%, 91% and 34% of patients, respectively. An eschar was observed in 11% of the cases. Complications included myocarditis with cardiogenic shock in 34% of the cases and acute kidney injury in 20% of the cases. Anicteric hepatitis and thrombocytopenia were observed in 31% and 61% of cases, respectively. One patient died.ConclusionsHigh incidences of myocarditis and acute kidney injury were observed, which indicates that the children were treated at a late stage of the disease. Clinicians should be cognizant that myocarditis and acute kidney injury are serious manifestations of pediatric scrub typhus.

► We studied the clinical profile and complications in pediatric scrub typhus. ► Thirty five children were diagnosed with scrub typhus over a one year period. ► High incidences of myocarditis and acute kidney injury were observed. ► Clinicians should be cognizant with these serious manifestations of scrub typhus.