Clinico-epidemiological and Outcome of Scrub Typhus in Paediatric Patients: An Observational Study from Odisha, India

Abstract

Introduction: Scrub typhus is re-emerging as a common prolonged febrile illness in children with serious complication involving major organ systems. It is easily treatable yet treatment is challenging with respect to early identification of predictors of serious disease that greatly affects the outcome in this vulnerable population. Aim: To study the clinical profile, analyse the complication and outcome of these patients. Materials and Methods: This was a hospital-based, prospective observational study. It was conducted in the Department of Paediatrics, SCB Medical College and Hospital, Cuttack from October 2017 to September 2019. All children with clinical features of scrub typhus were subjected to Immunoglobulin M (IgM) scrub typhus test. All observational data were analysed by IBM Statistical Package for the Social Science (SPSS) software, version 25.0 and Chi-square test was used with p<0.05 as statistically significant. Results: Out of total 196 subjects, majority 87 (44.4%) were found to be in the age group of 1-5 years of age and majority were males (55.1%). Fever was universally present (100%). Eschar, the pathognomonic lesion of scrub typhus was found only in 47.4% of the patients. Acute hepatitis was the most frequent complication encountered (33.2%). Majority (87.2%) of the patients improved and were successfully discharged. A total of 61 (31%) patients, out of the 196 included in the study, required admission to ICU. Mortality was more marked in patients suffering from shock, acute hepatitis, Acute kidney Injury, meningoencephalitis and myocarditis and Multiple Organ Dysfunction Syndrome (MODS) (p<0.05). Conclusion: Paediatric scrub typhus is quite common in the state of Odisha. Young age of presentation, presence of multi system involvement and delayed initiation of anti-rickettsial drugs due to delay in referral was also observed to be one of the poor prognostic factors.