title: Clinico - Laboratory Profile of Scrub Typhus - An Emerging Rickettsiosis in India.
abstract: OBJECTIVE
  To study the clinical and laboratory profile of pediatric scrub typhus in rural south India.
  
  
  METHODS
  This is a descriptive study of the clinical and laboratory features of 117 children with IgM ELISA proven scrub typhus out of 448 children, who were admitted in the Pediatric ward of a tertiary care hospital, during the study period of November 2014 through March 2015.
  
  
  RESULTS
  Fever was present in all 117 children, with mean duration of fever at admission as 9 d. Gastrointestinal tract was the most commonly affected system, seen in 51 % of children. Cough (82 %), myalgia (70 %), vomiting (68 %), headache (45 %) and pain abdomen (42 %) were the most common symptoms of scrub typhus. Hepatomegaly (70), splenomegaly (53 %), pallor (50 %) and eschar (41 %) were the common clinical findings in children with scrub typhus. Out of 49 children with eschar, 32 were associated with regional lymphadenopathy, which was commonly seen in axillary, neck and groin regions. Leucocytosis (50 %), anemia (56 %), increased SGOT / SGPT (47 %), thrombocytopenia (41 %), hypoalbuminemia (40 %) and hyponatremia (40 %) were the common lab features. Shock (46 %), myocarditis (24 %) and pneumonia (16 %) were the common complications seen in these children. This study showed that early treatment for scrub typhus results in a good outcome in terms of early recovery and nil mortality.
  
  
  CONCLUSIONS
  Regional lymphadenopathy is a marker of hidden or developing eschar. Total count and differential count should be interpreted on the background of the duration of fever. Since IgM ELISA, which is diagnostic of scrub typhus may not be widely available, any febrile child coming from rural area with hepatosplenomegaly, pallor, eschar, generalised / regional lymphadenopathy, anemia, leucocytosis, thrombocytopenia and increased Aspartate transaminase (AST) /Alanine aminotransferase (ALT) should be started on empirical Doxycycline or Azithromycin in order to prevent life threatening complications secondary to delay in therapy.
authors.affiliation: Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India. dinesh.paed@gmail.com.
authors.forename: Dinesh Kumar
authors.initials: DK
authors.lastname: Narayanasamy
authors.affiliation: Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India.
authors.forename: Arul Kumaran
authors.initials: AK
authors.lastname: Arunagirinathan
authors.affiliation: Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India.
authors.forename: Revathi Krishna
authors.initials: RK
authors.lastname: Kumar
authors.affiliation: Department of Pediatrics, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, 605107, Tamil Nadu, India.
authors.forename: V D
authors.initials: VD
authors.lastname: Raghavendran
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007194:India; D008297:Male; D012612:Scrub Typhus / Q000150:complications / Q000188:drug therapy / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline
keywords: Eschar; Leucocytosis; Lymphadenopathy; Rickettsial fever; Scrub typhus