title: Characteristics of pediatric scrub typhus during an outbreak in the North Eastern region of India: peculiarities in clinical presentation, laboratory findings and complications.
abstract: OBJECTIVE
  To identify and report a recent outbreak of scrub typhus cases recorded from October 2009 to January 2010 in the state of Meghalaya, India.
  
  
  METHODS
  The case sheets of all the children were retrieved and reviewed retrospectively. Twenty four (24) patients, who were both clinically and serologically confirmed as scrub typhus cases were included in the study.
  
  
  RESULTS
  Fever for more than 1 wk duration was the most common manifestation (100%) followed by splenomegaly (45.8%), eschar (41.7%), cough (37.5%), hepatomegaly (33.3%), headache and body ache (25%), pain abdomen (25%), vomiting (20.8%), altered sensorium (16.6%), seizures (12.5%) lymphadenopathy (12.5%), and loose stools (8.3%). Meningoencephalitis was the most common complication (29.2%) followed by pneumonia (16.3%) and subconjunctival hemorrhage (8.3%).Cortical blindness, septic shock, peritonitis, myocarditis with CCF, pancytopenia, acute renal failure, coagulopathy, prolonged oxygen dependency and urinary tract infection (UTI) were found in one of each case. Hyponatremia (66.7%), elevated liver enzymes without significant rise of bilirubin (58.3%), hypoalbuminemia (52.2%) and thrombocytopenia (26%) were the other significant laboratory findings. Patients were treated with chloramphenicol, doxycycline and azithromycin. There was no mortality.
  
  
  CONCLUSIONS
  This is the first outbreak report from the north eastern region of India with varied clinical presentations, laboratory investigations and complications. Weil Felix test still remains fruitful for diagnosing this disease in a resource limited set up.
authors.affiliation: Department of Pediatric Disciplines, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Mawdiangdiang, Shillong, Meghalaya, India. rashnadass@rediffmail.com
authors.forename: Rashna
authors.initials: R
authors.lastname: Dass
authors.forename: Nayan Mani
authors.initials: NM
authors.lastname: Deka
authors.forename: Sourabh Gohain
authors.initials: SG
authors.lastname: Duwarah
authors.forename: Himesh
authors.initials: H
authors.lastname: Barman
authors.forename: Rejaul
authors.initials: R
authors.lastname: Hoque
authors.forename: Dwijendra
authors.initials: D
authors.lastname: Mili
authors.forename: Dibakar
authors.initials: D
authors.lastname: Barthakur
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D002701:Chloramphenicol / Q000627:therapeutic use; D004196:Disease Outbreaks; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008590:Meningoencephalitis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012612:Scrub Typhus / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002701:Chloramphenicol; D017963:Azithromycin; D004318:Doxycycline