Characteristics of Pediatric Scrub Typhus Eschar in South Indian Children

Background: Knowledge of anatomic location of eschar is useful in diagnosing scrub typhus early in children and to initiate appropriate treatment. Methods: All children younger than 12 years of age admitted with confirmed diagnosis of scrub typhus over a 17-month period were included and the presence of eschar and other characteristics were recorded and analyzed. Results: Of 107 confirmed patients with scrub typhus, 37 (34.6%) presented with eschar. The site of eschar distribution was the face, 2.7%; neck, 5.4%; axilla, 18.9%; trunk, 10.8%; inguinal, 35.1%; and genitalia and buttocks, 27%. Lymphadenopathy was associated with 67.5% of eschars. The presence of eschar did not correlate with severity, complications, or response to therapy. Conclusion: Careful examination for eschar in children presenting with fever, particularly in the skin folds of the groin, genitalia, and axillae, can aid in early diagnosis of scrub typhus. Lymphadenopathy should alert the clinician to the possibility of finding an eschar in the drainage area.