Scrub typhus an emerging public health threat in Eastern Nepal: an analysis from a tertiary centre during two years outbreak

Shankar Prasad Yadav; Dinesh Dharel; Gauri Shankar Shah; Narayan Raj Bhattarai; Basudha Khanal

doi:10.18203/2349-3291.ijcp20183504

Authors

Shankar Prasad Yadav Department of Pediatrics, B. P. Koirala Institute of Health Science, Dharan, Nepal
Dinesh Dharel Department of Pediatrics, B. P. Koirala Institute of Health Science, Dharan, Nepal
Gauri Shankar Shah Department of Pediatrics, B. P. Koirala Institute of Health Science, Dharan, Nepal
Narayan Raj Bhattarai Department of Microbiology, B. P. Koirala Institute of Health Science, Dharan, Nepal
Basudha Khanal Department of Microbiology, B. P. Koirala Institute of Health Science, Dharan, Nepal

DOI:

https://doi.org/10.18203/2349-3291.ijcp20183504

Keywords:

Children, Complications, Diagnosis, Scrub typhus

Abstract

Background: Scrub typhus is an emerging disease in the eastern part of Nepal. Varied clinical presentation and lack of laboratory resources make diagnosis difficult. Epidemic outbreaks have been reported from different parts of Nepal. The objective of this study was to describe the clinical presentation, complications, laboratory profile and outcome of admitted cases with scrub typhus.

Methods: The cases (1 month to 15 years) admitted in paediatric ward or intensive care with confirmed serological diagnosis of scrub typhus over a period of two years 2015 and 2016, were retrospectively evaluated from the maintained records. All the clinical and laboratory parameters along with intervention and outcome were analysed by descriptive statistics.

Results: There were 52 cases of scrub typhus of which 30 were female and 22 males. The youngest case was 2.5 months old and the median age was 3.6 years, mode being 14 years (7 cases). Majority (>71%) of cases were from the hilly districts. Mean duration of illness at presentation was 7.8±2.7 days and ≥94% of the cases had temperature of ≥102°F. More than half of the cases had hepatomegaly (78%), splenomegaly (53.8%), respiratory symptoms (53.8%) and the classical eschar (55.8%). The mean haemoglobin of the cases was below 10 g/dl and the mean platelet count was below 70,000/cu mm, along with hyponatremia, hypoalbuminemia and elevated liver enzymes. X-rays showing variable infiltrates were seen in 59.6%. Respiratory complications like pneumonia and acute respiratory distress syndrome (ARDS) were seen in 46%, encephalopathy in 12%, myocarditis in 40.2%and acute kidney injury in 7.6%. Twenty percent of the cases required intensive care management. There was 15.4% mortality, and all the cases who succumbed had ARDS and myocarditis.

Conclusions: In this study the main clinical features were hepatomegaly, splenomegaly, respiratory symptoms and the classical eschar. Mortality was 15.4%. ARDS and myocarditis were present in all cases who died.

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