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

OBJECTIVE

To study the clinical profile of and complications in children with scrub typhus.

DESIGN

Prospective observational study.

SETTING

Tertiary care hospital.

METHODS

Children 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.

RESULTS

Thirty-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.

CONCLUSIONS

High 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.