Clinical Characteristics and Predictors of Severity of Pediatric Scrub Typhus in a Tertiary Level Hospital in South India

Elayaraja, S; Rajan, Mahalakshmi; Pasupathy, Umapathy; Ravichandran, Latha

doi:10.5812/pedinfect.92752

Cited by 13 publications

(12 citation statements)

References 17 publications

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“…About a third of the scrub typhus cases requiring hospitalization have multi-organ dysfunction with pulmonary, hepatic, cardiac, neurological, or renal complications leading to high fatality rates [6,10]. Studies from India reveal that the case fatality rate (CFR) of scrub typhus ranges from 1.3% to 33.5% depending on the organ involvement and complications present [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

The burden of scrub typhus in India: A systematic review

et al. 2021

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Background Scrub typhus, a vector-borne zoonotic infection caused by the bacteria Orientia tsutsugamushi, is one of the most common and clinically important rickettsial infections worldwide. An estimated one million cases occur annually with a high case fatality rate. Although scrub typhus is a major public health threat in India, the burden and distribution remains unclear. We aimed to estimate the burden of scrub typhus in India. Methodology We performed a systematic review of published literature on scrub typhus from India to extract information on epidemiology, morbidity, and mortality. Important databases were searched using keywords and appropriate combinations. We identified observational, interventional, and population-based studies and extracted the data to evaluate the number of cases diagnosed using serology or PCR and the number of deaths due to scrub typhus. We conducted a systematic narrative synthesis to summarize included studies. Principal findings In the last decade, there were 18,781 confirmed scrub typhus cases reported in 138 hospital-based studies and two community-based studies. IgM ELISA was used in 122 studies to confirm the cases in majority (89%). The proportion of scrub typhus among acute undifferentiated febrile illness (AUFI) studies was 25.3%, and community seroprevalence was 34.2%. Ninety studies had data published on multiple organ involvement out of which 17.4% of cases had multiple organ dysfunction syndromes, 20.4% patients required ICU admission, and 19.1% needed ventilation. The overall case-fatality rate was 6.3%, and the mortality among those with multi-organ dysfunction syndrome was as high as 38.9%. Conclusion/significance Scrub typhus, a common acute febrile illness in India causing severe morbidity, accounts for a large number of deaths. The burden of the disease has been underappreciated. Early diagnosis and prompt treatment can significantly reduce complications and mortality. Establishing good surveillance and instituting appropriate control measures are urgently needed.

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Section: Introductionmentioning

confidence: 99%

The burden of scrub typhus in India: A systematic review

et al. 2021

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“…5,10,16 Clinically significant icterus was present in only 7.8% cases with average bilirubin level 0.4±0.13 mg/dL in our study. 11 Interestingly, some pediatric studies have reported jaundice in as high as 30.7% cases. 10,14 Although very common in acute viral hepatitis, jaundice is not a common finding in scrub typhus, hence appropriately termed as anicteric hepatitis.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Both these findings in absence of eschar have been studied as disease severity indicators. 9,11 Despite having such importance from clinical and prognostic point of views, there are few studies concentrating upon hepatic profile of scrub typhus, especially in pediatric population. 12 Majority of such studies are based on adult population and pediatric data on scrub typhus associated hepatic injury is scarce.…”

Section: Introductionmentioning

confidence: 99%

Clinico-demographic and hepatic profile as outcome predictor in scrub typhus in pediatric age group

et al. 2023

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Background: Scrub Typhus, a Rickettsial disease is an emerging tropical disease mainly in South East Asia. Very few studies are there in pediatric age group and mainly limited to epidemiological and clinical profile only. Aims and Objectives: The main objective of this study is to assess different clinical, laboratory, and biochemical parameters denoting hepatic function in scrub typhus and their role in measuring final outcome and disease severity. Materials and Methods: This observational study included 90 children with history of febrile illness for ≥5 days between 1 and 12 years of age, diagnosed to be a case of scrub typhus by positive IgM ELISA test to assess the hepatic involvement by different clinical, laboratory, and radiological parameters and also to find out their role in disease severity and outcome. Results: Fever followed by vomiting was the most common symptoms with eschar evident in only three patients. Raised aspartate transaminase (AST) and alanine transaminase (ALT) were seen in 71.1% and 64.4%, respectively, with hypoalbuminemia in 78.9%, hepatomegaly in 47.8%, and only 2.2% had altered hepatic echotexture on ultrasonography. All of them had ALT: lactate dehydrogenase (LDH) ratio of <5. Shock was the most important predictor of duration of hospital stay whereas serum AST was an important predictor for final outcome and duration of hospital stay. Conclusion: Predominant feature of hepatic involvement in scrub typhus resembles that of anicteric hepatitis. Serum ALT: LDH ratio may be an important indicator of scrub hepatitis. Among lab parameters serum AST is the most important predictor of disease mortality and morbidity.

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“…Severe hypoalbuminemia was considered if the serum level was <2.5 gm/dl. 3 Prolonged international normalized ratio (INR) was defined as INR>1.5.…”

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confidence: 99%

Clinical profile and predictors of severity in children with scrub typhus admitted to paediatric intensive care unit

Aroor

Mundkur

Kumar

2023

Int J Contemp Pediatr

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Background: Scrub typhus accounts for a significant portion of morbidity and mortality related to tropical infectious diseases. This study is done to determine the factors associated with complications and outcome in children with scrub typhus. Methods: It is a retrospective descriptive study conducted on children diagnosed with scrub typhus (IgM) admitted to the paediatric intensive care unit at a tertiary care centre in south India during 1 year of study period. Clinical profile, laboratory parameters, course of illness and outcome data were collected and analysed. Results: The study population included 88 children with scrub typhus. 32 children required intensive care unit admission. Remaining 56 children were included in non-severe scrub typhus group. Complications of scrub typhus included hepatic dysfunction (100%), pneumonitis 16 (50 %), meningoencephalitis 12 (37.5%), shock 12 (37.5%), acute respiratory distress syndrome (ARDS) 4 (12.5%), myocarditis 4 (12.5%), acute kidney injury (AKI) 2 (6.25%), multiple organ dysfunction syndrome (MODS) 2 (6.25%) and purpura fulminans 1 (3.1%). Mortality was observed in 2 (1.3%) children. It was found that anaemia and leucocytosis were predominantly associated with the risk of severe scrub typhus (odds ratio of 6.43 and 30.4 respectively, p value <0.001). Among other laboratory parameters, C-reactive protein (CRP) of >30 and hypoalbuminemia were significantly associated with mortality (p value <0.001). The median CRP and AST levels were significantly high in the severe scrub typhus group (p value 0.02 and 0.012 respectively). Conclusions: Hepatic dysfunction was present in all children admitted to PICU. Children with scrub typhus had an increased risk of developing complications in the presence of anaemia, leucocytosis, CRP>30 mg/l and severe hypoalbuminemia.

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Clinical Characteristics and Predictors of Severity of Pediatric Scrub Typhus in a Tertiary Level Hospital in South India

Cited by 13 publications

References 17 publications

The burden of scrub typhus in India: A systematic review

The burden of scrub typhus in India: A systematic review

Clinico-demographic and hepatic profile as outcome predictor in scrub typhus in pediatric age group

Clinical profile and predictors of severity in children with scrub typhus admitted to paediatric intensive care unit

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