CLINICAL PROFILE OF PEDIATRIC SCRUB TYPHUS PATIENTS: A HOSPITAL BASED STUDY

BACKGROUND: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The organism is transmitted during the bite of trombiculid mites. Field rodents are the reservoir hosts. The disease is endemic in many parts of India including the state of Jammu and Kashmir but is often under reported due to lack of diagnostic facilities. AIM: The aim was to study the clinical and epidemiological profile of pediatric scrub typhus patients reporting to the Department of Pediatrics, Government Medical College Jammu, a referral hospital for whole of Jammu region. METHODS: Prospective study conducted in the Department of Pediatrics Govt. Medical College Jammu from January 2011 to December 2011. A total of 90 children who reported with fever and rash or lymphadenopathy or both were tested using qualitative ELISA for IgM antibodies against Orientia tsutsugamushi. The clinical and epidemiological profile of 74 pediatric scrub typhus patients who tested positive for IgM ELISA for Scrub typhus was studied. OBSERVATION: Most (71.6%) patients were in the age group of 6-15 years. 83% of them reported in the months of September and October. One third of the patients belonged to Rajouri district. Common physical signs were fever (100%), rash (86.4%) and generalised lymphadenopathy (83.7%). Others included conjuctival congestion (44.59%), hepatosplenomegaly (36.48%), jaundice (22.97%), edema (18.91%), eschar (17.56%), meningeal signs (10.81%), and myocarditis (5.4%). Most of the children presented late with complications like hepatic dysfunction (55.4%), renal dysfunction (24.32 %), shock (4%) meningoencephalitis (9.4%), gastrointestinal haemorrhage (8.1%) and myocarditis (4.05 %), bronchopneumonia (4.05%) and multiorgan involvement (2.7%). Children were treated with chloramphenicol or doxycycline. There was no mortality in the study group. CONCLUSION: Scrub typhus is endemic in the Jammu region especially Nowshera-Sunderbani-Rajouri belt. Children with Scrub typhus can have severe complications but respond promptly to treatment. As good serological tests are not freely available in all endemic areas in the emphasis should be on the clinical diagnosis and prompt treatment.