DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20221236

A study on clinico-epidemiological profile of scrub typhus in rural Bengal and therapeutic response to known drugs

Gopal Pandey

Abstract


Background: Scrub typhus is an important cause of fever in South and East Asia and the Pacific, but is grossly underdiagnosed due to lack of awareness. This was a prospective observational study to study the clinical profile of scrub typhus in paediatric population in a tertiary care hospital in Rural Bengal of Malda district.

Methods: The study was conducted from May 2021 to November 2021 among children presenting to OPD and admitted in IPD of Malda Medical College and Hospital in the Deparment of Paediatrics. Children under the age of 12 years presenting with signs and symptoms suggestive of scrub typhus were included in this study and serological diagnosis was confirmed by Scrub IgM ELISA with a positive titre >0.5.

Results: Out of the 178 cases enrolled in our study, 136 were confirmed positive by ELISA. All the cases were admitted with fever (100%), other symptoms were vomiting (77.9%), cough (68.3%), abdominal pain (57.3%), maculopapular rash (52.9%), headache (49.2%), myalgia (41.1%), oedema (30.8%), conjunctival congestion (23.5%). Hepatomegaly (91.1%), splenomegaly (83.8%) and lymphadenopathy (75%) were the most common signs. Oral doxycycline in doses of 5 mg/kg/day in 2 divided doses were given in half the cases (68) and azithromycin (10 mg/kg/day) were given in 34 cases, while 34 cases were given oral chloramphenicol (75 mg/kg/day). Doxycycline and chloramphenicol were equally effective with defervescence in maximum cases within 48 hrs. Azithromycin response was poor with fever persisting in 80% cases after 48 hrs.

Conclusions: Scrub typhus must be included in the differential diagnosis of acute febrile illness in children with or without eschar for its early detection and prompt treatment leading to favourable outcome. Doxycycline or Chloramphenicol were equally effective in treatment while Azithromycin showed poor response.


Keywords


Scrub typhus, Prevalence, Rural Bengal, Antibiotic response

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References


Nelson textbook of paediatrics,chapter 229, page 1504

Taylor AJ, Paris DH, Newton PN, A systemic review of mortality from untreated scru typhus (OrientiaTsutsugamushi). PLoSNegl Trop Dis 2015; 9:e0003971.

Mittal M, Thangaraj JWV, Rose W, Verghese VP, Kumar CPG, Mittal GM, et al. Scrub typhus as a cause of acute encephalitis syndrome, Gorakhpur, Uttar Pradesh, India. Emerging Infect Dis. 2017;23:1414-16.

Murhekar MV. Acute encephalitis syndrome and scrub typhus in Indi. Emerg Infect Dis.2017;23:1434.

Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S.Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. Journal of Infection and Public Health 2012;5(1):82-8

Sankhyan, N.; Saptharishi, L.G.; Sasidaran, K.; Kanga, A.; Singhi, S.C. Clinical profile of scrub typhus in

children and its association with hemophagocyticlymphohistiocytosis. Indian Pediatr.2014, 51, 651–653.

Dass R, Deka NM, Duwarah SG, Barman H, Hoque R, Mili D, et al. Characteristics of paediatric scrub typhus during an outbreak in the North Easern region of India: peculiarities in clinical presentation,laboratory findings and complications. Indian journal of Pediatrics 2011;78(11)1365-70

Digra SK, Saini GS, Singh V, Dutt Sharma S, Kaul R. Scrub typhus in children: Jammu Experience. JK Science 2010; 12(2):95-7

Rajendran A. Scrub typhus in pediatric age group: A report from a tertiary care hospital. Journal of Pediatric Sciences 2011;3(2):e82.

Zainab M,Gupta AK, Guha S. Scrub Typhus in children. J Nepal Paediatric Soc 2018;38(1):59-62

Kamarasu K. MalathiM,Rajagopal V, Subramani K, JagadeeshramasamyD,Mathai E. Serological evidence for wide distribution of spotted fevers & typhus fever in Tamil Nadu/. Indian J Med Res.2007 Aug;126(2):128-130.

RathiN,RathiA.Rickettsial infections: Indian perspective. Indian Pediatrics2010; 47(2):157-64

El Sayed I,LiuQ,Wee I, Hine P. Antibiotics for treating scrub typhus. Cochrane Database of Systematic Reviews 2018,Issue 9, Art No.;CD002150

Chakraborty S, Chakraborty S, Banerjee T, Banerjee C, Bera P, Pravin A. Typhus fever – A diagnostic dilemma, Journal of paediatric infectious diseases 2015; 10(01): 32-4

Batra, H. spotted fevers and typhus fever in Tamil Nadu – commentary, Indian journal of Medical reaserach 2007; 126:101-3