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  • Title: Scrub typhus in rural Rajasthan and a review of other Indian studies.
    Author: Masand R, Yadav R, Purohit A, Tomar BS.
    Journal: Paediatr Int Child Health; 2016 May; 36(2):148-53. PubMed ID: 25704650.
    Abstract:
    BACKGROUND: Scrub typhus is an acute febrile illness which has been reported from various parts of India with Rajasthan recently joining the list of affected states. AIM: To report a series of paediatric scrub typhus cases from rural Rajasthan. STUDY DESIGN: Retrospective review of children with scrub typhus admitted to the wards and paediatric intensive care unit (PICU) of a tertiary-care hospital. METHODS: The study was undertaken over an 8-month period from May to December 2013. All patients with a clinical presentation and/or serological confirmation of scrub typhus who tested negative for malaria, enteric fever, dengue, leptospirosis and urinary tract infection (UTI) were included. A range of investigations were undertaken including IgM-ELISA for scrub typhus, followed by appropriate medical management. RESULTS: Thirty patients satisfied the inclusion criteria. The mean (SD, range) age of the patients was 8·56 (3·43, 3-16) years. The most common clinical features were fever (n = 30, 100%), headache (n = 20, 66%), myalgia (n = 15, 50%), hepatosplenomegaly (n = 18, 60%) and pallor (n = 5, 16%). Typical features such as eschar and rash were observed in only one (3·3%) and three (10%) patients, respectively; none had generalised lymphadenopathy or conjunctival congestion. IgM-ELISA for scrub typhus was positive in 28 patients (93·3%) and 27 responded to doxycycline within 24-72 hours. One of the three patients who required PICU support responded to intravenous chloramphenicol and, of the other two (6·6%), one died of acute respiratory distress syndrome and the other owing to acute renal failure. CONCLUSION: A high index of suspicion is essential for early diagnosis and prevention of complications in scrub typhus together with prompt referral from rural areas to a higher centre. Awareness of the disease manifestations may further help to prevent excessive investigations in patients presenting with non-specific febrile illness and reduce the economic burden to the family and society in resource-constrained settings.
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