Characteristics of Pediatric Scrub Typhus during an Outbreak in the North Eastern Region of India: Peculiarities in Clinical Presentation, Laboratory Findings and Complications

Dass, Rashna; Deka, Nayan Mani; Duwarah, Sourabh Gohain; Barman, Himesh; Hoque, Rejaul; Mili, Dwijendra; Barthakur, Dibakar

doi:10.1007/s12098-011-0470-5

Cited by 74 publications

(103 citation statements)

References 12 publications

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“…Rickettsial diseases have been reported from the various parts of India and are showing a trend of re-emergence [1][2][3][4][5][6][7][8][9]. More than 75% of our cases occurred during the fourth and fifth year of our five-year analysis.…”

Section: Discussionmentioning

confidence: 95%

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Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Thomas

Puranik

Kalal

et al. 2016

J Infect Dev Ctries

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Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive WeilFelix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%. Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.

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Section: Discussionmentioning

confidence: 95%

“…Rickettsial disease has been reported from various parts of India, such as Tamil Nadu, Karnataka, Kerala, Maharashtra, and some parts of northern India [1][2][3][4][5][6][7][8][9]. The infection has established itself as an endemic disease in Southeast Asia including Thailand, China, and Taiwan [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Thomas

Puranik

Kalal

et al. 2016

J Infect Dev Ctries

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“…Dass R et al reported seizures in 12.5 % of cases and altered sensorium in 16.6 % of cases. In their study, meningoencephalitis was seen in 29.2% of untreated cases of which 2 patients with low GCS were ventilated for 4 days each (9) , Palanivel et al (5) reported altered sensorium in 58% of cases.…”

Section: Study Hepatomegaly Lymphadenopathy Escharmentioning

confidence: 85%

“…All other causes of fever were ruled out. Palanivel et al (5) , Inamdar et al (6) , Udayan U et al (3) , Dass R et al (9) also found fever in all children.…”

Section: Clinical Featuresmentioning

confidence: 92%

An Observational Study of Clinical Features of Scrub Typhus

E¹

2017

jmscr

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“…Over one-third of patients with scrub typhus present with gastrointestinal symptoms. 3,4 Primary intra-abdominal processes leading to secondary peritonitis are numerous, including diseases or injuries of the gastrointestinal or genitourinary tracts. 5 Peritonitis in patients with scrub typhus has never been reported.…”

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confidence: 99%

Peritonitis in Patients with Scrub Typhus

Lee

Lee²,

Yoon³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. Various complications have been reported in scrub typhus cases including acute respiratory distress syndrome, encephalitis, pneumonia, pericarditis, acute renal failure, and acute hepatic failure. Few studies have reported on the gastrointestinal manifestations of scrub typhus. Typical gastrointestinal manifestations in patients with scrub typhus include abdominal pain, nausea, vomiting, hematemesis, melena, and diarrhea. The two cases presented in this study are the first reported cases of peritonitis associated with scrub typhus. This study shows that scrub typhus should also be included in the differential diagnosis of peritonitis in areas where Orientia tsutsugamushi is endemic.Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, which is transmitted to humans through the bite of the larva of trombiculid mites. The major pathology of scrub typhus is focal or disseminated vasculitis caused by destruction of endothelial cells and organ-system dysfunction.

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Characteristics of Pediatric Scrub Typhus during an Outbreak in the North Eastern Region of India: Peculiarities in Clinical Presentation, Laboratory Findings and Complications

Abstract: This is the first outbreak report from the north eastern region of India with varied clinical presentations, laboratory investigations and complications. Weil Felix test still remains fruitful for diagnosing this disease in a resource limited set up.

Cited by 74 publications

References 12 publications

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

An Observational Study of Clinical Features of Scrub Typhus

Peritonitis in Patients with Scrub Typhus

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