857 Clinical profile of presentation of pediatric scrub typhus in post-lockdown era in Tamil Nadu, India

Abstract

<h3>Background</h3> Scrub typhus is an important differential diagnosis of acute febrile illness in rural portions of south India. It is caused by Orientia tsutsugamoshii and spreads thru mites. Prior studies have documented various its prevalence between 19–32% in Tamil Nadu, India with a wide spectrum of clinical manifestation. Due to COVID restrictions and lockdowns, there has been a reduced emphasis and under-diagnosis of non-coronavirus illnesses across the world. <h3>Objectives</h3> This study aims to study the clinical profile of Presentation of Scrub Typhus in pediatric population at a tertiary care hospital in Tamil Nadu, India <h3>Methods</h3> The study was conducted as a prospective, observational hospital based study at a tertiary care hospital in Tamil Nadu, India. As an institutional protocol, Scrub Typhus IgM ELISA is done for all cases with a history of fever more than 5 days in addition to cases with a strong clinical suspicion due to presence of eschar. Since the COVID-19 pandemic, RT-PCR has been done for all cases of Acute febrile illness. The study included 134 cases that were Scrub IgM positive among children aged 2–12 years between October-December 2020. 4 children who were both Scrub Typhus IgM positive and COVID RT-PCR positive were excluded from the study The children were treated as per the IAP Consensus statement guidelines on Scrub Typhus with first line therapy by Doxycycline and second line therapy of Azithromycin in addition to symptomatic management. Demographic details, symptoms, course in hospital and outcome were tabulated. <h3>Results</h3> 132 children presented with fever, 56 with headache, 44 with myalgia, 67 with complaints of cough, 48 had rash. 80 children had a typical eschar out of which 44 were on limbs, 20 were over trunk, 6 over scrotum, 5 behind ear and 5 near perineum. 127 children responded to Doxycycline within 48 hours, 3 children responded to doxycycline within 72 hours and 4 cases responded to combination therapy of Doxycycline and Azithromycin. <h3>Conclusions</h3> Scrub typhus remains an important disease in children with variable presentations even in post-coronavirus lockdown era. There is a need to focus on these illnesses as the world is recovering from the pandemic.