A study on clinical profile, complications and outcome of scrub typhus in south Indian children

J. Balaji, P. Punitha, B. Ramesh Babu, K. S. Kumaravel


Background: Rickettsial diseases including Scrub Typhus are emerging as an important cause of acute undifferentiated febrile illness throughout the Asia-Pacific region. The objectives of the study are to study the clinical profile, complications and outcome of Scrub Typhus cases admitted in rural medical college.

Methods: This prospective descriptive study was done at Government Dharmapuri Medical College Hospital, Tamilnadu, between Jul’2015 and Jan’2016. The children who were positive for Scrub Typhus by IgM Elisa were analyzed.

Results: During the study period, 151 children (40% of fever cases) were positive for Scrub Typhus. All the children were presented with fever. High-grade fever, chills, vomiting, cough, head ache, were seen in 83%, 41%, 57%, 56% and 32% respectively. 54% of children had lethargy and 10% children brought with convulsions to hospital. Eschar was seen in 68% of children. Lymphadenopathy (70%) and hepatosplenomegaly (more than 56%) were common findings. Shock, respiratory distress, pleural effusion and ascites were seen in 46%, 36%, 40% and 37% respectively. Anemia (74%) and thrombocytopenia (81%) were common lab findings. Shock (46%), ARDS (12%), Meningoencephalitis (10%) and MODS (1.3%) were complications reported. Doxycycline (53%), Azithromycin (11%) and both drugs (36%) were used. Along with fluids, Dopamine (38%), nor-adrenaline (12%), Oxygen through Jackson-Rees Circuit (28%), Non-invasive ventilation (9%) was needed to treat the complications.

Conclusions: When a child presents with acute febrile illness, hepatospleenomegaly, lymphadenopathy, anemia with thrombocytopenia and features suggestive of capilary leak diagnosis of Scrub Typhus must be considered. Doxycycline or Azithromycin, proper fluid boluses, Inotropes and O2 through Jackson-Rees Circuit are life saving for scrub typhus and its complications.


ARDS, Children, Doxycycline, Rickettsial infections, Scrub typhus, Shock

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Mahajan A, Jasrotia DS, Charak RS, et al. Scrub typhus: Jammu outbreak-2009. JK Science (J Med Edu Res). 2010;12:98-101.

Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D, Mathai E. Serological evidence for wide distribution of spotted fevers and typhus fever in Tamil Nadu. Indian J Med Res. 2007;126:128-30.

Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. Indian P Pediatr. 2012;79(11):1459-62.

Rathi NB, Rathi AN, Goodman MH, Aghai ZH. Rickettsial diseases in central India: Proposed clinical scoring system for early detection of spotted fever. Indian Pediatr. 2011;48:867-72.

Reller ME, Dumler JS. Scrub typhus (Orientia tsutsugamushi). In: Kliegman, Stanton, Geme St, Schor, eds. Nelson textbook of Pediatrics. First South Asia edition. New Delhi, Reed Elsevier India Pvt. Ltd. 2016:1504-5.

Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India. 2010;58:24-8.

Rathi N, Rathi A. Rickettsial infections. Indian Pediatr. 2010;47:157-64.

Digra SK, Saini GS, Singh V, Sharma SD, Kaul R. Scrub typhus in children: Jammu experience. JK Science (J Med Educ Res). 2010;12:95-7.

Paris DH, Shelite TR, Day NP and Walker DH. Review Article: Unresolved Problems related to scrub typhus: A seriously neglected life-threatening disease. Am J Trop. Med. Hyg. 2013;89(2):301-7.

DHR-ICMR Guidelines for diagnosis and management of Rickettsial diseases in India. Department of Health Research and Indian Council of Medical Research; 2015.

Mathai E, Rolain JM, Verghese GM. Outbreak of Scrub Typhus in Southern India during the cooler months. Ann. New York Acad Sci. 2003;990:359-64.

Mahajan SK, Kashyap R, Kanga A. Relevance of Weil Felix Test in Diagnosis of Scrub Typhus in India. J Assoc Physician India .2006;54:619-21.

Khandelwal S, Meena JK, Sharma BS. Scrub typhus in children: Clinical profile and complications. 10.7199/Ped.Oncall.2015.68. Volume 12. Issue 4.

Rajendran A. Scrub Typhus in paediatric age group: A report from a tertiary care hospital. J Pediatr Sci. 2011;3:82.

Chanta C, Chanta S. Clinical study of 20 children with scrub typhus at Chiang Rai Regional Hospital. J Med Assoc Thai. 2005;88:1867-72.