Pediatric scrub typhus in Southern Kerala: An emerging public health problem

Background: Scrub typhus is a potentially fatal rickettsial infection endemic in Asia. But there are only very few reports of pediatric scrub typhus from Southern Kerala, which is situated in South India. Objective: To study the clinicoepidemiological profile of pediatric patients with scrub typhus in Southern Kerala. Methods: Clinical profile of 108 consecutive, 1- to 12-year-old children diagnosed with scrub typhus admitted in a tertiary care teaching hospital in South India from August 2011 to May 2015 was studied. Results: The median age of affected children was 6.83 years with a male to female ratio 1.42:1. Definite clustering of cases was noted from Nedumangaud Taluk, a hilly area in Trivandrum district (24%). A seasonal pattern was observed with a peak during the months of August-January (84.26%). Most common symptoms apart from fever were cough, abdominal pain, and vomiting. Most common signs were splenomegaly in 68.52% of cases and lymph node enlargement in 59.26% of cases. Eschar was present in 44.44% of cases, with the commonest site being inguinal region. Complications were seen in 9.25% of cases. Myocarditis was the most common complication and one case had associated coronary artery dilatation also. Case fatality rate was only 0.93%. Doxycycline and azithromycin were the antibiotics used. Fever subsided within 24 h of starting treatment in 73.15% of cases and within 48 h in 84.26% of cases. Conclusion: Scrub typhus is a common cause of fever in South India. Awareness among medical professional should be a high priority as late detection is the cause of failure of treatment, complications, and even mortality. (C) 2016 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.