title: Characteristics of pediatric scrub typhus in a new endemic region of northern China.
abstract: 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.
authors.affiliation: Chinese People's Liberation Army General Hospital, Department of Hospital Infection Control, Beijing, People's Republic of China.
authors.forename: Yun-Xi
authors.initials: YX
authors.lastname: Liu
authors.forename: Na
authors.initials: N
authors.lastname: Jia
authors.forename: Ji-Jiang
authors.initials: JJ
authors.lastname: Suo
authors.forename: Yu-Bin
authors.initials: YB
authors.lastname: Xing
authors.forename: Gang
authors.initials: G
authors.lastname: Liu
authors.forename: Hong-Ju
authors.initials: HJ
authors.lastname: Xiao
authors.forename: Ning
authors.initials: N
authors.lastname: Jia
authors.forename: Zhong-Tang
authors.initials: ZT
authors.lastname: Zhao
authors.forename: Jing-Si
authors.initials: JS
authors.lastname: Min
authors.forename: Pei-Tian
authors.initials: PT
authors.lastname: Feng
authors.forename: Shu-Bin
authors.initials: SB
authors.lastname: Ma
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.forename: Wu-Chun
authors.initials: WC
authors.lastname: Cao
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D002701:Chloramphenicol