Predictors of severity factors associated with severe scrub typhus among children in a tertiary care hospital

Background & objectives:Scrub typhus is an acute febrile zoonotic disease caused by the obligate intracellular gram-negative bacteria Orientia tsutsugamushi. Growing data over the last few years from the Indian subcontinent suggest that it is one of the most widespread but under-reported diseases. This study aimed to document the clinical and paraclinical profiles and evaluate complications of scrub typhus in severe and non-severe pediatric age groups.Methods:A prospective observational study was conducted in pediatric patients. Frequency, mean, percentage and standard deviation were included in the descriptive statistical analysis calculations. Multivariate analysis was conducted to predict the severity factor.Results:A total of 189 patients met the eligibility criteria and were included in the final analysis. The mean and standard deviation (mean +/- SD) age of the cohort was 5.54 +/- 3.9 years, with a male predominance of 68.2%. The mean +/- SD duration of fever was 6.64 +/- 1.43 days. Patients with severe scrub typhus experienced complications including hepatic involvement (42, 64.6%), respiratory distress (23, 46.1%), neurological involvement (14, 24.6%), acute kidney injury (10, 15.4%), myocarditis (9, 13.8%), and (16, 24.6%) have multi-organ dysfunction. Patients with raised transaminases (> 180 IU/L) have a 3.7 to 4.1 times greater chance of developing severity. Thrombocytopenia is found to be another independent predictor of severe scrub typhus.Interpretation & conclusion:Clinical signs of hepatomegaly, skin rash, and lymphadenopathy were significant predictors of severity. Delay in treatment is a key contributor to the severity of pediatric scrub typhus.