Prevalence of scrub typhus in children among acute fever in a tertiary care hospital

Budhia Majhi, B Maheswar Rao, Saroj Sekhar Rath, Saroj Ku. Barma

Abstract


Introduction: Scrub typhus along with other rickettsial infections are under-diagnosed in India because of their non-specific clinical presentation, low index of suspicion among physicians and lack of diagnostic facilities. It is a common cause of acute febrile illness in India. Scrub typhus can lead to different complications such as refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute kidney injury and myocarditis. In southern part of Odisha, there are limited studies of scrub typhus available in children. With this background this study was conducted to estimate
the prevalence of scrub typhus in children presenting with acute febrile illness of more than or equal to five days in a tertiary care teaching hospital. 
Materials and Methods: This was a cross sectional study carried out on a convenience sample of 283 children aged 2 to 14 years during the period from October 2017 to September 2019 in the O.P.D and I.P.D of the Department of Pediatrics, M.K.C.G. Medical College and Hospital, Berhampur. All children
with acute undifferentiated fever of more than or equal to 5 days duration were included in the study. All confirmed cases of scrub typhus had a positive serology. Serology was done in all children who had fever for more than or equal to five days. Those with positive serology for scrub were studied in detail in relation to demography, clinical features and hematological profile. Data was presented as percentage and mean SD.
Results: During the study a total of 283 children with 5 days of acute fever aged between 2 to 14yrs were evaluated. Out of the total samples analyzed, 100 (35.5%) cases were diagnosed to be positive for scrub typhus by IgM ELISA, 72 (25.4%) for malaria, ARI cases found to be 26 (9.1%), sickle cell disease with sepsis in 22 (7.7%), typhoid in 19 (6.7%) cases, dengue in 21 (7.4%), acute bacterial meningitis in 12 (4.2%) cases and leukemia was found in 11 cases (3.8%). Most of the cases of scrub typhus were in the age
group 2 to 6 years with a male preponderance and a peak occurrence in the month of September, showing a typical seasonal pattern.
Conclusion: The prevalence of scrub typhus was 35.5% among children with acute undifferentiated fever lasting five days or more with a seasonal pattern with a post monsoon and early winter surge.

Keywords: Acute undifferentiated fever, Children, Prevalance, Scrub typhus.


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