Clinical study & laborotory profile of rickettsial fever in children- a study from rural Maharashtra

Abstract

Introduction: Rickettsial fever has been reported to be endemic in the Himalayan belt, Maharashtra and Karnataka in India among the adult population. Pediatric data on the same is limited in developing countries. Recently, the profile of rickettsial fever has been described in children in South India with similar clinical features. Material Methods: This study was conducted from the patients admitted in our hospital, Ashwini Rural Medical College, Hospital & RC, Solapur, from the month of January 2014 to June 2015. The inclusion criteria were, clinical suspicion & supportive lab evidence-Weil Felix, positive leucocytosis, thrombocytopenia. Results: In our study age of presentation ranged from 6 months to 12 years, with mean age of 7 yrs, there was no statistically significant sex difference. All patients presented with fever & purpuric rash was seen in 82%, altered sensorium was seen in 58%, seizures were seen 34% & Hepatosplenomegaly was seen in 65% of cases. Other investigations: In our study CSF examination was done in 25 patients of which 10 had abnormal findings, 6 showed low sugar and 8 high protein. In our study according to the Weil Felix titers, most probable disease would be tick borne spotted fever or epidemic typhus, since no louse infestation (the scalp and body infestation, lymphadenopathy) was seen in any of the patients, and most of them were from rural areas more chances of tick infestation. Conclusions: The diagnosis of rickettsia should always be kept in mind for workup of exanthematous fever. High index of clinical suspicion and good laboratory co-relation are helpful in detection of more no of cases. Early diagnosis and treatment with doxy and chloramphenicol can reduce the hospital stay and cost. Associated mixed infections may mislead diagnosis and are more fatal. Weil Felix test is not diagnostic standard. It should be interpreted in good clinical context, still it is easily available to all & remains good screening test.