Chitwan Medical College, Nepal
Title: Clinical Profile, Complications and Outcome of Scrub Typhus in Children- A Hospital Based Observational Study in Central Nepal
Dr. Santosh Pathak is an assistant professor in Chitwan Medical College. He completed his MD from Universal College of medical sciences in 2016. He published his paper in several national and international journals. He has attended several international and national conferences on pediatric.
INTRODUCTION: Scrub typhus, an important cause of pyrexia of unknown origin, is grossly neglected in low and middle income countries like Nepal. This study was conducted to study the clinical profile and complications of scrub typhus in children along with the outcome. MATERIAL AND METHODS: A prospective observational was study done in children (1-16 years) diagnosed as scrub typhus admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA.RESULTS: All cases of scrub typhus presented with fever. Other common symptoms were headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). Necrotic eschar was present in 11.8%. Thrombocytopenia raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%) and severe thrombocytopenia (22.4%), Doxycycline was commonly used (69.7%) in the treatment followed by combination with azithromycin (18.4%). Overall mortality rate was 3.9%. CONCLUSION: Scrub typhus should be considered as an important differential in all patients with acute febrile illness in endemic areas. Presence of eschar along with thrombocytopenia, deranged liver enzymes and renal function test in a febrile child should arise a suspicion of scrub typhus and empirical doxycycline/azithromycin in such cases can be lifesaving. KEY WORDS: Scrub typhus, rickettsial infections, clinical features, complications, children