title: Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever.
abstract: OBJECTIVE
  To report a series of cases of rickettsial infections from central India and to develop a clinical scoring system for its early detection.
  
  
  METHODS
  Retrospective review of children hospitalized during one year period with fever without a source, and presence of one or more of the clinical features suggestive of rickettsial infection. Diagnosis of rickettsial disease was made by classical clinical features and detection of IgM antibody by ELISA. A clinical scoring system was developed to diagnose spotted fever group by using classical clinical and laboratory findings.
  
  
  RESULTS
  161 patients were admitted and met the inclusion criteria, 75 (45.6%) were diagnosed with rickettsial diseases. 52 (69.3%) had spotted fever group and 23 (30.7%) scrub typhus. The mortality rate with rickettsial diseases was 9%. By using proposed clinical scoring system, a score of 14 has sensitivity and specificity of 96.15% and 98.84%, respectively in making a diagnosis of spotted fever group.
  
  
  CONCLUSIONS
  Rickettsial diseases are common in the central part of India and should be included in the differential diagnosis of patients with fever of undetermined source. The proposed scoring system can be used for early detection, treatment and prevention of mortality and morbidity from spotted fever group.
authors.affiliation: Rathi Childrens Hospital and Maternity Home, Akola, MS, India. drnbrathi@hotmail.com
authors.forename: Narendra B
authors.initials: NB
authors.lastname: Rathi
authors.forename: Akanksha N
authors.initials: AN
authors.lastname: Rathi
authors.forename: Michael H
authors.initials: MH
authors.lastname: Goodman
authors.forename: Zubair H
authors.initials: ZH
authors.lastname: Aghai
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012282:Rickettsia Infections / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult