Clinico-laboratory profile and outcome of rickettsia in children: Hubli (Karnataka) experience

Abstract

Abstract Aims To study the clinical and laboratory profile and outcome of rickettisial disease in children in the age group of 0–12 years. Methods Prospective hospital based study conducted at Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli from June 2011 to May 2012. Inclusion criteria All children in the age group of 0–12 years having fulfilled following criteria (i) Children with history of fever, rash, headache, myalgia, vomiting, oedema with (ii) Positive Weil–Felix test and/or (iii) Exposure/presence of tick/or mite/or louse on body. Exclusion criteria (i) Children who are positive for dengue serology (ii) Clinically suspected other viral infection (measles, enteroviral exanthems, dengue, infectious mononucleosis), protozoal (malaria), bacteria (meningococcemia, leptospirosis, scarlet fever) and collagen vascular (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions. A detailed clinical history, physical examination was carried out for all enrolled children. Complete haemogram, electrolytes and radiological examination was done whenever required. All children received doxycycline 2.2 mg/kg/dose every 12th hourly orally till 5–7 days or till 3 days following the afebrile period. Results Total number of children enrolled during the study was 36. Male:Female ratio was 1:1 (18:18). The mean age of presentation was 5.6 years (range 5 months–12 years). The most common clinical symptoms/signs were fever 36 (100%), rash 20 (55%), hepatomegaly 25 (69%), splenomegaly 18 (50%), pallor 18 (50%), pedal oedema 14 (38%) and ascities 6 (16%). Among the laboratory profile thrombocytopaenia was seen in 27% cases, hyponatremia in 71.4% cases. No mortality was present in this series. Conclusion Rickettisia is a re-emerging disease. The most clinical manifestation was very non-specific. High index of clinical suspicion is needed to make diagnosis.