title: Clinical profile of scrub typhus in children.
abstract: OBJECTIVE
  To study the clinical profile and outcome of scrub typhus cases admitted in an urban referral centre.
  
  
  METHODS
  This descriptive study describes the clinical profile of 67 children with scrub typhus, who were admitted in an urban referral centre(ICH & HC,Chennai) during the period between October 2010 and March 2011.The diagnosis was confirmed by IgM ELISA.
  
  
  RESULTS
  All children presented with fever. Eschar and rash were present in 46% and 35% cases, respectively. Cough, vomiting, altered sensorium and oliguria were present in 73%,59%,58% and 43%, respectively. Hepatosplenomegaly and pallor were the commonest findings encountered in more than 80% children. Other findings were edema, lymphadenopathy and icterus.Thrombocytopenia, elevated liver enzymes and leukocytosis were seen in 77%, 64% and 49% cases, respectively. Pleural effusion, ascites, shock and respiratory failure were seen in 61%, 47%,45%,34% cases, respectively. Acute renal failure, hepatic failure, multiorgan dysfunction syndrome (MODS), meningoencephalitis and acute respiratory distress syndrome(ARDS) were seen in 10%,10%,7%,6% and 4% cases, respectively. Doxycycline and azithromycin were the antibiotics used. The overall mortality rate was 11.94%. Causes of death were shock, ARDS, acute renal failure(ARF), MODS and disseminated intravascular coagulation(DIVC).
  
  
  CONCLUSIONS
  When a child presents with acute febrile illness, maculopapular or erythematous rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and features suggestive of capillary leak, diagnosis of Scrub typhus must be considered and the child should be started on empirical therapy with doxycycline or azithromycin which is life saving.
authors.affiliation: Department of Pediatrics, Institute of Child Health and Hospital for Children, Egmore, Chennai-8, Tamil Nadu, India. drpalanivel84@gmail.com
authors.forename: Sengottaiyan
authors.initials: S
authors.lastname: Palanivel
authors.forename: Krishnamoorthi
authors.initials: K
authors.lastname: Nedunchelian
authors.forename: Varadharajan
authors.initials: V
authors.lastname: Poovazhagi
authors.forename: Rangaswamy
authors.initials: R
authors.lastname: Raghunadan
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Ramachandran
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D017963:Azithromycin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004318:Doxycycline / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012285:Orientia tsutsugamushi / Q000276:immunology; D012612:Scrub Typhus / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D015415:Biomarkers; D007075:Immunoglobulin M; D017963:Azithromycin; D004318:Doxycycline