Characteristics of pediatric scrub typhus in a new endemic region of northern China.
BACKGROUND
Scrub typhus emerged in northern China in 1986. Our objective was to document epidemiologic, clinical and laboratory features of pediatric scrub typhus in this new endemic area.


METHODS
The pediatric patients diagnosed with scrub typhus during the 12-year period from 1995 through 2006 in Feixian County, Shandong province were enrolled in the study. The cases were diagnosed based on either specific antibody detection using the indirect immunofluorescent assay or detection of partial Orientia tsutsugamushi gene by polymerase chain reaction.


RESULTS
Seventy pediatric scrub typhus cases were included in the study. The cases occurred from September through November. The common clinical manifestations included headache (100%), skin rash (91%), eschar (84%), lymphadenopathy (61%), and gastrointestinal signs (56%). None of the patients had neurologic involvement or thrombocytopenia. All children responded well to treatment with chloramphenicol. The patients who presented with abnormal chest radiography took significantly longer time to defervescence (Z[r] = 2.528, P = 0.011). Three strains of O. tsutsugamushi were isolated and all were identified as Kawasaki type.


CONCLUSIONS
The manifestations of pediatric scrub typhus cases in the novel endemic region of northern China may be less severe than in other regions. Careful examination of skin eschars is helpful for the clinical diagnosis.
Liu
Yun-Xi
YX
Chinese People's Liberation Army General Hospital, Department of Hospital Infection Control, Beijing, People's Republic of China.
Jia
Na
N
Suo
Ji-Jiang
JJ
Xing
Yu-Bin
YB
Liu
Gang
G
Xiao
Hong-Ju
HJ
Jia
Ning
N
Zhao
Zhong-Tang
ZT
Min
Jing-Si
JS
Feng
Pei-Tian
PT
Ma
Shu-Bin
SB
Richardus
Jan Hendrik
JH
Cao
Wu-Chun
WC
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D002701:Chloramphenicol / Q000627:therapeutic use; D019353:Endemic Diseases; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007223:Infant; D008297:Male; D012285:Orientia tsutsugamushi / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012612:Scrub Typhus / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D002701:Chloramphenicol