Distribution of Eschar in Pediatric Scrub Typhus.

BACKGROUND

Identifying an eschar in scrub typhus is useful for initiation of prompt and appropriate antibiotic therapy.

METHODS

The distribution of eschars in all children <15 years of age admitted with confirmed scrub typhus over a 5 year period is described.

RESULTS

Of 431 children admitted with scrub typhus, eschars were present in 176 (40.8%) children with the following distribution: head, face and neck, 33 (19.1%); axillae, 37 (21%); chest and abdomen, 21 (11.9%); genitalia, inguinal region and buttocks, 58 (33%); back, 8 (4.5%); upper extremities, 13 (7.4%); and lower extremities, 5 (2.8%). The commonest sites of eschars were scrotum (27 of 106; 25.5%) and axillae (15 of 106; 14.2%) in males and axillae (22 of 70; 31.4%) and groin (16 of 70; 22.9%) in females. Eschars were seen within skin folds in 100 of 176 (56.8%) children.

CONCLUSION

Children should be carefully examined for the presence of eschar especially in the skin folds of the genitalia, axillae and groin to make an early diagnosis of scrub typhus.