title: Scrub typhus in rural Rajasthan and a review of other Indian studies.
abstract: Scrub typhus is an acute febrile illness which has been reported from various parts of India with Rajasthan recently joining the list of affected states.
  
  
  
  To report a series of paediatric scrub typhus cases from rural Rajasthan.
  
  
  
  Retrospective review of children with scrub typhus admitted to the wards and paediatric intensive care unit (PICU) of a tertiary-care hospital.
  
  
  
  The study was undertaken over an 8-month period from May to December 2013. All patients with a clinical presentation and/or serological confirmation of scrub typhus who tested negative for malaria, enteric fever, dengue, leptospirosis and urinary tract infection (UTI) were included. A range of investigations were undertaken including IgM-ELISA for scrub typhus, followed by appropriate medical management.
  
  
  
  Thirty patients satisfied the inclusion criteria. The mean (SD, range) age of the patients was 8·56 (3·43, 3-16) years. The most common clinical features were fever (n = 30, 100%), headache (n = 20, 66%), myalgia (n = 15, 50%), hepatosplenomegaly (n = 18, 60%) and pallor (n = 5, 16%). Typical features such as eschar and rash were observed in only one (3·3%) and three (10%) patients, respectively; none had generalised lymphadenopathy or conjunctival congestion. IgM-ELISA for scrub typhus was positive in 28 patients (93·3%) and 27 responded to doxycycline within 24-72 hours. One of the three patients who required PICU support responded to intravenous chloramphenicol and, of the other two (6·6%), one died of acute respiratory distress syndrome and the other owing to acute renal failure.
  
  
  
  A high index of suspicion is essential for early diagnosis and prevention of complications in scrub typhus together with prompt referral from rural areas to a higher centre. Awareness of the disease manifestations may further help to prevent excessive investigations in patients presenting with non-specific febrile illness and reduce the economic burden to the family and society in resource-constrained settings.
authors.affiliation: a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Masand
authors.affiliation: a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Yadav
authors.affiliation: a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.
authors.forename: Alok
authors.initials: A
authors.lastname: Purohit
authors.affiliation: a Department of Paediatrics, National Institute of Medical Sciences , Jaipur , Rajasthan , India.
authors.forename: Balvir Singh
authors.initials: BS
authors.lastname: Tomar
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D012612:Scrub Typhus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Children; India; Rural; Scrub typhus