Dinesh Kumar Narayanasamy1, Thirunavukkarasu Arun Babu2, Vijayasankar Vijayadevagaran1, Devi Kittu3, Shanthi Ananthakrishnan1. 1. Department of Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India. 2. Department of Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India. babuarun@yahoo.com. 3. Department of Preventive & Social Medicine, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India.
Abstract
OBJECTIVE: To identify the factors that can predict the severity of scrub typhus in children. METHODS: This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children <12y of age admitted with fever for more than 7d and positive IgM ELISA for scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of 'severe scrub typhus' were identified based on criteria from published adult and pediatric studies. RESULTS: Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of 'severe scrub typhus' in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the 'severe scrub typhus' cases. CONCLUSIONS: Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.
OBJECTIVE: To identify the factors that can predict the severity of scrub typhus in children. METHODS: This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children <12y of age admitted with fever for more than 7d and positive IgM ELISA for scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of 'severe scrub typhus' were identified based on criteria from published adult and pediatric studies. RESULTS: Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of 'severe scrub typhus' in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the 'severe scrub typhus' cases. CONCLUSIONS:Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.
Authors: George M Varghese; Jeshina Janardhanan; Sanjay K Mahajan; David Tariang; Paul Trowbridge; John A J Prakash; Thambu David; Sowmya Sathendra; O C Abraham Journal: Emerg Infect Dis Date: 2015-01 Impact factor: 6.883
Authors: Kartika Saraswati; Brittany J Maguire; Alistair R D McLean; Sauman Singh-Phulgenda; Roland C Ngu; Paul N Newton; Nicholas P J Day; Philippe J Guérin Journal: PLoS Negl Trop Dis Date: 2021-10-14