title: Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications.
abstract: OBJECTIVE
  To study the clinical profile and complications of childhood scrub typhus.
  
  
  METHODS
  Prospective observational study of 66 children with scrub typhus, admitted to a tertiary hospital in north India, during the period between January 2011 and December 2012. The diagnosis was confirmed by serology. Findings : All children presented with fever. Other common symptoms were vomiting (56%), facial swelling (52%), cough (35%), abdominal pain (33%), breathlessness (29%) and decreased urine output (29%). High grade fever (>101 (o)F) was recorded in 91% of children. Other common signs were hepatomegaly, splenomegaly, edema, tender lymphadenopathy and hypotension, observed in 82%, 59%, 39%, 38% and 36% of cases, respectively. An eschar and a maculopapular rash each were observed in 20% of patients. Meningoencephalitis (30.3%), severe thrombocytopenia (27.2%), shock (25.8%), acute kidney injury (16.7%) and hepatitis (13.6%) were the most common complications observed in these children. Other common complications were acute respiratory distress syndrome, respiratory failure requiring ventilation, bronchopneumonia and myocarditis. Ninety percent of children became afebrile within 48 hours of initiating an appropriate antibiotic. Median time to defervescence was 22 hours. The overall mortality rate was 7.5%. Causes of death were refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute kidney injury and myocarditis.
  
  
  CONCLUSIONS
  Pediatricians should keep a high index of suspicion for scrub typhus in any febrile child having a maculopapular rash, hepatosplenomegaly, tender lymphadenopathy, thrombocytopenia and features suggestive of capillary leak. Pending serological confirmation, empirical therapy with doxycycline or azithromycin should be started, as delay in treatment would result in life threatening complications.
authors.affiliation: Department of Pediartics.
authors.forename: Nowneet
authors.initials: N
authors.lastname: Kumar Bhat
authors.affiliation: Department of Medicine.
authors.forename: Minakshi
authors.initials: M
authors.lastname: Dhar
authors.affiliation: Department of Microbiology.
authors.forename: Garima
authors.initials: G
authors.lastname: Mittal
authors.affiliation: Department of Pathology, Himaliyan Institute of Medical Sciences, Swami Rama Himalayan University, Doiwala, Dehradun, Uttarakhand, India.
authors.forename: Nadia
authors.initials: N
authors.lastname: Shirazi
authors.affiliation: Department of Pediartics.
authors.forename: Anil
authors.initials: A
authors.lastname: Rawat
authors.affiliation: Department of Pediartics.
authors.forename: Bram
authors.initials: B
authors.lastname: Prakash Kalra
authors.affiliation: Department of Pediartics.
authors.forename: Vipan
authors.initials: V
authors.lastname: Chandar
authors.affiliation: Department of Medicine.
authors.forename: Sohaib
authors.initials: S
authors.lastname: Ahmad
keywords: Eschar; Meningoencephalitis; Mite; Rash; Scrub Typhus