Clinical Profile, Outcome, and Atypical Presentations of Scrub Typhus: Experience from a Tertiary Care Center in South India

Abstract

Background The aim of this study was to describe the clinical profile and atypical presentations of scrub typhus in children aged younger than 12 years admitted to a tertiary care center in south India.

Materials and Methods A retrospective chart review of children diagnosed with scrub typhus from January 2014 to January 2015 was performed; the clinical features (including atypical presentations), laboratory parameters, and response to treatment were analyzed.

Results The majority of the cases was from urban areas and presented with gastrointestinal manifestations (25/31). Eschar was noted in 23 children (74%) and was typically found above the level of the umbilicus. All cases showed a rapid resolution with doxycycline. Atypical presentations included massive lung consolidation, epididymo-orchitis, secondary hemophagocytic lymphohistiocytosis, and “Kawasaki-like” disease. Infants in the group presented with low to moderate grade fever, significant hepatosplenomegaly, high C-reactive protein, and leukocytosis with lymphocytic preponderance. We propose that this tetrad of features, even in the absence of an eschar, should point to a possible diagnosis of scrub typhus in infants.

Conclusion Changes in typical presentation of pediatric scrub typhus present a continuing diagnostic challenge.

Keywords

scrub typhus - eschar - atypical features

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