Scrub Typhus in Children

Introduction: Scrub typhus is an acute febrile illness caused by infection with rickettsial bacilli Orientia tsutsugamushi. This was a retrospective observational study to study the clinical profile of paediatric scrub typhus, its associated complications and response to treatmentMaterial and Methods: Record files of all patients diagnosed with positive Weil felix (OXK>1:80) and Scrub IgM positive over a period of one year were analysed. Total of 10 cases were diagnosed as scrub with median age of presentation 4.1 years.Results: Fever was present in all followed by pain abdomen (50%), rash. Anaemia (90%), lymphadenopathy (70%) hepatomegaly (100%), Leukopenia was present in those cases with fever <1 week while leucocytosis was found thereafter. Most common complication were hepatitis (100%) shock (50%), acute kidney injury (AKI) 30%, DIC in 20% cases. Secondary HLH was found in 20% and pancarditis in one case. All the cases showed dramatic response to doxycycline.Conclusion: So a high index of suspicion is required to diagnose scrub and early initiation of treatment is essential to prevent mortality from the disease.

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A study of incidence and outcome of acute kidney injury in common undifferentiated febrile illnesses

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200224 ◽

2020 ◽

Vol 8 (2) ◽

pp. 497

Author(s):

Jacob Cherian ◽

Divya Deodhar

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Febrile Illness ◽

Risk Category ◽

Acute Febrile Illness ◽

Female Ratio ◽

Delay In Diagnosis ◽

Medical College ◽

Injury Category ◽

One Year

Background: Patients presenting with acute undifferentiated febrile illness may have delay in diagnosis due to nonspecific symptoms and signs. Kidney injury in these patients can cause detrimental effect on their prognosis and hence early diagnosis is warranted.Methods: This is an observational prospective study conducted in the Department of Medicine at Christian Medical College and Hospital, Ludhiana for a period of one year from 1st November 2014 till 31st October 2015.Results: Among the 532 patients acute febrile illness included in the study, 437(82.1%) were diagnosed with dengue fever. A total of 190(35.7%) patients were diagnosed to have AKI. The incidence of AKI in specific diseases was found to be the highest in Malaria 8(61.5%) out of 13 patients). In AKI, majority of them were in the risk category with 97(51.0%). A total of 26(13.6%) patients with AKI required Hemodialysis. Among the 190 patients who had AKI 43(22.6%) died.Conclusions: Dengue was the most common acute febrile illness. Among the patients with acute kidney injury majority were in the risk category with 97(18.2%). 326(61.2%) patients were males with a male to female ratio was found to be 1.5: 1. Dengue with acute kidney injury had the most proportion of patients in the risk and injury category and malaria with acute kidney injury having the highest proportion in failure category. The highest incidence of patients with AKI requiring hemodialysis was seen in scrub typhus. Leptospirosis with AKI had the highest proportion of mortality. The failure category had the highest proportion of mortality.

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Scrub Typhus Is an Under-recognized Cause of Acute Febrile Illness with Acute Kidney Injury in India

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0002605 ◽

2014 ◽

Vol 8 (1) ◽

pp. e2605 ◽

Cited By ~ 28

Author(s):

Vivek Kumar ◽

Vinod Kumar ◽

Ashok K. Yadav ◽

Sreenivasa Iyengar ◽

Ashish Bhalla ◽

...

Keyword(s):

Acute Kidney Injury ◽

Scrub Typhus ◽

Kidney Injury ◽

Febrile Illness ◽

Acute Febrile Illness

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Scrub Typhus and Molecular Characterization of Orientia tsutsugamushi from Central Nepal

Pathogens ◽

10.3390/pathogens10040422 ◽

2021 ◽

Vol 10 (4) ◽

pp. 422

Author(s):

Rajendra Gautam ◽

Keshab Parajuli ◽

Mythili Tadepalli ◽

Stephen Graves ◽

John Stenos ◽

...

Keyword(s):

Genetic Diversity ◽

Scrub Typhus ◽

Febrile Illness ◽

Acute Febrile Illness ◽

Limited Information ◽

Orientia Tsutsugamushi ◽

Health Measures ◽

Central Nepal ◽

Vector Borne

Scrub typhus is a vector-borne, acute febrile illness caused by Orientia tsutsugamushi. Scrub typhus continues to be an important but neglected tropical disease in Nepal. Information on this pathogen in Nepal is limited to serological surveys with little information available on molecular methods to detect O. tsutsugamushi. Limited information exists on the genetic diversity of this pathogen. A total of 282 blood samples were obtained from patients with suspected scrub typhus from central Nepal and 84 (30%) were positive for O. tsutsugamushi by 16S rRNA qPCR. Positive samples were further subjected to 56 kDa and 47 kDa molecular typing and molecularly compared to other O. tsutsugamushi strains. Phylogenetic analysis revealed that Nepalese O. tsutsugamushi strains largely cluster together and cluster away from other O. tsutsugamushi strains from Asia and elsewhere. One exception was the sample of Nepal_1, with its partial 56 kDa sequence clustering more closely with non-Nepalese O. tsutsugamushi 56 kDa sequences, potentially indicating that homologous recombination may influence the genetic diversity of strains in this region. Knowledge on the circulating strains in Nepal is important to the development of diagnostic tests and vaccines to support public health measures to control scrub typhus in this country.

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The Revelations of Acute Kidney Injury in Cases of Acute Febrile Illness – A Hospital Based Observational Study from North Eastern India

Advancements in Journal of Urology and Nephrology ◽

10.33140/ajun.02.01.04 ◽

2020 ◽

Vol 2 (1) ◽

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Urine Volume ◽

Kidney Injury ◽

Febrile Illness ◽

Hospitalized Patients ◽

Acute Febrile Illness ◽

Medical College ◽

Definition Of ◽

Unexpected Outcome

Background: Clinicians across the globe refer to the published KDIGO definition of Acute Kidney Injury (AKI) as one of the following: • An increase in serum creatinine by ≥0.3 mg/dl (≥26.5 µmol/l) within 48 hrs • An increase in serum creatinine to ≥1.5 times baseline within the previous 7 days • Urine volume <0.5 ml/kg/h for 6 hrs Acute febrile illnesses are a common cause of AKI in hospitalized patients. The present study was undertaken to evaluate the incidence of AKI in patients presenting with acute febrile illness and also study the different etiological factors responsible for acute febrile illness. Materials and Methods: The study included 200 patients of acute febrile illness admitted in Silchar Medical College And Hospital in the Department of Medicine over a period of 24 months. The data regarding the various causes such as the etiology of fever, kidney function tests and other parameters of the cases were obtained and analyzed using simple statistical methods. Results and Observations: A total of 52 patients (26%) with acute febrile illness due to etiologies like Leptospirosis, Falciparum Malaria, Enteric fever, Dengue, Scrub Typhus, and mixed Malaria, etc developed AKI out of the 200 admitted cases presenting with acute febrile illness. Conclusion: The incidence of AKI is common in hospitalized patients of acute febrile illness and a thorough evaluation and detailed clinicobiochemical monitoring of the patients are necessary as it has varied etiology and often lead to an unfavorable or even unexpected outcome.

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Clinical Profile of Acute Kidney Injury in Acute Febrile Illness with Thrombocytopenia

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v6i8.77 ◽

2018 ◽

Vol 6 (8) ◽

Author(s):

Dr Arjun. V. A ◽

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Febrile Illness ◽

Clinical Profile ◽

Acute Febrile Illness

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Acute kidney injury in tropical acute febrile illness in a tertiary care centre--RIFLE criteria validation

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfq477 ◽

2010 ◽

Vol 26 (2) ◽

pp. 524-531 ◽

Cited By ~ 46

Author(s):

G. Basu ◽

A. Chrispal ◽

H. Boorugu ◽

K. G. Gopinath ◽

S. Chandy ◽

...

Keyword(s):

Acute Kidney Injury ◽

Tertiary Care ◽

Kidney Injury ◽

Febrile Illness ◽

Acute Febrile Illness ◽

Care Centre ◽

Tertiary Care Centre ◽

Rifle Criteria

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A study of clinical and laboratory profile of scrub typhus in children in a tertiary hospital in South India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20170693 ◽

2017 ◽

Vol 4 (2) ◽

pp. 482

Author(s):

Radha Kumar ◽

Purusothaman Srinivasan

Keyword(s):

Tamil Nadu ◽

Scrub Typhus ◽

Febrile Illness ◽

Tertiary Hospital ◽

Response To Therapy ◽

Acute Febrile Illness ◽

College Hospital ◽

Medical College ◽

Laboratory Profile ◽

High Index Of Suspicion

Background: Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi. The present study was conducted to study the clinical features, laboratory profile, complications and response to therapy among children suffering from scrub typhus in a tertiary health care institution of Tamil Nadu, India.Methods: The study was conducted at Saveetha Medical College Hospital, Tamil Nadu, India. Duration of the study was from August to December, 2015 in the Department of Pediatrics. Children with clinically suspected Scrub typhus were subjected to detailed clinical examination and investigation. Diagnosis of scrub typhus was confirmed by IgM ELISA. Results: 34 patients were diagnosed as suffering from scrub typhus. Common symptoms noted were fever, headache, cough and cold, chills, rigor, myalgia and vomiting. The common complications noted were thrombocytopenia in 16 children (47%) and features of meningoencephalitis and hepatitis were present in 2 children (5.8%). Eschar was identified in 24 (70.5%) patients. Mixed infection was seen in 4 (11.7%) children who had concurrent culture positive Urinary Tract Infection. Conclusions: Scrub typhus is an acute febrile illness which requires high index of suspicion for early diagnosis, monitoring of the clinical and laboratory parameters and prompt treatment which may help in complete cure without further complications and morbidity.

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Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central Nepal

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4010027 ◽

2019 ◽

Vol 4 (1) ◽

pp. 27 ◽

Cited By ~ 4

Author(s):

Rajendra Gautam ◽

Keshab Parajuli ◽

Jeevan Bahadur Sherchand

Keyword(s):

Risk Factors ◽

Seasonal Variation ◽

Confidence Interval ◽

Odds Ratio ◽

Scrub Typhus ◽

Public Awareness ◽

Febrile Illness ◽

Acute Febrile Illness ◽

Orientia Tsutsugamushi ◽

Central Nepal

Orientia. tsutsugamushi, a zoonotic bacterial infection common in the region known as the tsutsugamushi triangle. This study aims to determine the seroprevalence, seasonal variation, and risk factors of scrub typhus among the acute febrile illness patients attending different hospitals of central Nepal. Blood samples were collected from hospitalized patients of acute febrile illness suspected of scrub typhus infection attending different hospitals of central Nepal from April 2017 to March 2018. The IgM antibody to Orientia tsutsugamushi was detected by using the Scrub Typhus Detect™ Kit. Among the total cases (1585), 358 (22.58%) were positive for IgM Antibodies. Multivariate analysis identified several risks factors to be significantly associated with the scrub typhus infection, including gender (female) (odds ratio [OR] = 1.976, p ≤ 0.001, confidence interval [CI] = 1.417–2.756), rural residential location (odds ratio [OR] = 0.431, p = 0.001, confidence interval [CI] = 0.260–0.715), house near grassland (odds ratio [OR] = 3.288, p ≤ 0.001, confidence interval [CI] = 1.935–5.587), and working in the field (odds ratio [OR] = 9.764, p = 0.004, confidence interval [CI] = 2.059–46.315). The study findings indicate scrub typhus infection to be a significant health problem in Nepal. The proper diagnosis of infection cases, timely institution of therapy, public awareness, and vector control are important measures to be taken for the prevention and management of scrub typhus.

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Scrub typhus associated acute kidney injury in a 33-year-old male

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20213250 ◽

2021 ◽

Vol 8 (9) ◽

pp. 1427

Author(s):

Nyamnyei Konyak ◽

Medo M. Kuotsu ◽

Labresai Mog ◽

Sandipa Roy Chowdhury ◽

Prity Ering ◽

...

Keyword(s):

Acute Kidney Injury ◽

Acute Respiratory Distress Syndrome ◽

Early Diagnosis ◽

Renal Impairment ◽

Distress Syndrome ◽

Scrub Typhus ◽

Kidney Injury ◽

High Morbidity ◽

Orientia Tsutsugamushi ◽

Typhus Fever

Scrub typhus or bush typhus is caused by Orientia tsutsugamushi. An eschar at the site of bite is evidentiary of scrub typhus. Increased mortality is seen in cases presenting with acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), pneumonitis, meningitis, myocarditis and multi-organ dysfunction. Renal impairment in scrub typhus should be identified and management initiated early to prevent the progress of the damage. Scrub typhus if left undiagnosed and untreated results in high morbidity and mortality. Here we report a case of a 33-year-old male with AKI following scrub typhus fever. In our case early diagnosis and management led the patient to recovery.

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