Abstract
BackgroundScrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children.MethodsA prospective observational study was carried out in children aged 1–16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA.ResultsAll cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%.ConclusionsScrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.
Highlights
Scrub typhus, an important cause of tropical fever in northern Australia, the western Pacific islands and South Asia including India and Nepal, is caused by a zoonotic obligate intracellular, gram negative bacteria, transmitted by a bite of trombuculid mite, the chigger [1, 2].The disease is grossly under-diagnosed in low and middle income countries (LMICs) as the presentation and index of suspicion is low among clinicians
Scrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar
An important cause of tropical fever in northern Australia, the western Pacific islands and South Asia including India and Nepal, is caused by a zoonotic obligate intracellular, gram negative bacteria, transmitted by a bite of trombuculid mite, the chigger [1, 2].The disease is grossly under-diagnosed in low and middle income countries (LMICs) as the presentation and index of suspicion is low among clinicians
Summary
An important cause of tropical fever in northern Australia, the western Pacific islands and South Asia including India and Nepal, is caused by a zoonotic obligate intracellular, gram negative bacteria, transmitted by a bite of trombuculid mite, the chigger [1, 2].The disease is grossly under-diagnosed in low and middle income countries (LMICs) as the presentation and index of suspicion is low among clinicians. Scrub typhus in Nepal was first ever reported in 1981 and a hospital based study carried out in 2004 found 28 cases of scrub typhus among 876 enrolled febrile patients [3]. In a recent study (2017) conducted in National Public health laboratory (Nepal) reported that 40.3% of blood samples collected from patients with acute febrile illness were positive for IgM against O. tsutsugamushi [4]. A hospital based study was conducted in Chitwan district of central Nepal to study the clinico-laboratory profile and therapeutic outcome of scrub typhus in children aged 1–16 years of life. An important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. Editor: Ulrike Gertrud Munderloh, University of Minnesota, UNITED STATES Received: February 27, 2019 Accepted: July 25, 2019 Published: August 13, 2019
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