Clinical Predictors of Multiple Organ Dysfunction Syndromes in Pediatric patients with Scrub Typhus

Abstract

Scrub typhus can produce multiple organ dysfunction syndrome (MODS). Early recognition of the patients at risk of MODS would be helpful in providing timely management and reducing the mortality. In all, 449 children with scrub typhus were enrolled at three hospitals in Yunnan, China from January 2010 to January 2015. The patients' clinical status of organ system dysfunction was evaluated on the day of discharge from hospital by using standard criteria. The patients were classified into MODS present (64 cases, 14.3%) or MODS absent (385 cases, 85.7%). Multivariate logistic regression analyses revealed that the prognostic factors for MODS included skin rash (odds ratio, OR = 3.3, p = 0.037), time interval form treatment to defervescence (OR = 1.2, p = 0.035), hemoglobin (OR = 0.54, p = 0.041), platelet counts (OR = 0.06, p < 0.001), aspartate-aminotransferase (OR = 4.7, p = 0.011) and total bilirubin (OR = 2.3, p = 0.013). By describing risk factors resulting in MODS in pediatric scrub typhus, our study provides clinicians with important information to improve the clinical monitoring and prognostication of MODS.

Dysregulated Th1 Immune and Vascular Responses in Scrub Typhus Pathogenesis

“…Patients with low IL-10 and miR-155 levels are more vulnerable to a cytokine storm and severe pathology (53). Thrombocytopenia observed in severe scrub typhus patients (52, 54–56) and the failure of platelet count normalization, even after a general improvement of other markers of multi-organ dysfunction, imply for immune-mediated thrombocytopenia mechanism (57). These clinical studies collectively indicate immune system dysregulation in scrub typhus patients, but the nature and the mechanisms of immune dysfunction have not been investigated.…”

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

“…The exclusion criteria in this study were as follows: children using long-term medications, immunodeficiency, and have a chronic disease. Severity of the disease was defined based on previously published adult and pediatric studies (7)(8)(9)(10)(11)(12)(13). The study population was divided into two groups in terms of disease severity: (1) non-severe, patients without any complications and (2) severe, patients with severe complications.…”

Hyperferritinemia in pediatric scrub typhus: A prospective observational study

“…Hematological dysfunction is prominent; most have thrombocytopenia with varying degrees of anemia and disseminated intravascular coagulation (DIC) [6]. Other organ dysfunctions are not uncommon and have an additive association with mortality [7][8][9][10].…”

“…Several clinical and laboratory parameters have been studied to predict organ dysfunction and survival in children with scrub typhus with inconsistent results [2,[10][11][12]. Ferritin can be an attractive marker as hematological dysfunction is prominent in scrub typhus especially in those with MODS [13].…”