Clinical and laboratory profile of pediatric scrub typhus in a tertiary care teaching hospital in Southern India


  • Selvakumar Lakshmanan Department of Paediatrics, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
  • Benjamin Sagayaraj M. Department of Paediatrics, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
  • Balamma Sujatha Department of Paediatrics, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
  • Lal Devayani Vasudevan Department of Paediatrics, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India



Acute undifferentiated fever, Eschar, Orientia tsutsugamushi, Rickettsial infections, Scrub typhus, Weil-Felix test


Background: Scrub typhus is a common aetiology for an acute undifferentiated fever among children. Early recognition and prompt management help to reduce morbidity and mortality.

Methods: All children who visited our pediatric out-patient department between January 2016 and February 2018, admitted with clinical suspicion of scrub typhus and having positive serum IgM by ELISA were included in the study.

Results: A total of 83 cases were enrolled during the study period. Of these 55 were boys and 28 girls. The average age of presentation was seven years, and the youngest was just five months old. Majority of these patients were from rural areas (86%). Roughly, two-thirds (77%) of the study group practiced open defecation. A maximum number of cases (65;78.3%) were reported during monsoon season (between September and January).

Prolonged fever (100%), gastrointestinal symptoms (76%) such as vomiting, diarrhoea and abdominal pain, lymphadenopathy (96%) and hepatosplenomegaly (61%) were common signs and symptoms of pediatric scrub typhus. Only six patients had severe illnesses. The diagnosis was based on the positive serum IgM for scrub typhus. All the patients were IgM positive. Out of these 83 patients, eschar was seen in 50 (60%) patients. Weil Felix test was positive in 15 cases out of 33 tested cases. Six children had co-infection with 2 cases of malaria and four dengue fever cases.

Conclusions: Scrub typhus is one of the common causes for acute undifferentiated fever among children. A high index of clinical suspicion and a lookout for an eschar shall facilitate an early diagnosis of scrub typhus.

Author Biography

Benjamin Sagayaraj M., Department of Paediatrics, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India



Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. Indian J Pediatr. 2012;79(11):1459-62.

Jung H-C, Chon S-B, Oh WS, Lee D-H, Lee H-J. Etiologies of acute undifferentiated fever and clinical prediction of scrub typhus in a non-tropical endemic area. Am J Trop Med Hyg. 2015;92(2):256-61.

Kelly DJ, Fuerst PA, Ching W-M, Richards AL. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin infect dis off publ infect dis soc Am. 2009;48 (3): S203-30.

Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003;16(5):429-36

Somashekar HR, Moses PD, Pavithran S, Mathew LG, Agarwal I, Rolain JM, et al. Magnitude and features of scrub typhus and spotted fever in children in India. J Trop Pediatr. 2006;52(3):228-9.

Thomas R, Puranik P, Kalal B, Britto C, Kamalesh S, Rego S, et al. Five-year analysis of Rickettsial fevers in children in South India: Clinical manifestations and complications. J Infect Dev Ctries. 2016;10(6):657-61.

Batra HV. Spotted fevers and typhus fever in Tamil Nadu. Indian J Med Res. 2007;126(2):101-3.

Kumar Bhat N, Dhar M, Mittal G, Shirazi N, Rawat A, Prakash Kalra B, et al. Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications. Iran J Pediatr. 2014;24(4):387-92.

Giri PP, Roy J, Saha A. Scrub Typhus - a major cause of pediatric intensive care admission and multiple organ dysfunction syndrome: A single-center experience from India. Indian J Crit Care Med Peer-Rev off Publ Indian Soc Crit Care Med. 2018;22(2):107-10.

Narayanasamy DK, Arunagirinathan AK, Kumar RK, Raghavendran VD. Clinico - Laboratory profile of scrub typhus - an emerging rickettsiosis in India. Indian J Pediatr. 2016;29.

Dass R, Deka NM, Duwarah SG, Barman H, Hoque R, Mili D, et al. Characteristics of Pediatric scrub typhus during an outbreak in the North Eastern region of India: peculiarities in clinical presentation, laboratory findings and complications. Indian J Pediatr. 2011;78(11):1365-70.

Premraj SS, Mayilananthi K, Krishnan D, Padmanabhan K, Rajasekaran D. Clinical profile and risk factors associated with severe scrub typhus infection among non-ICU patients in Semi-urban south India. J Vector Borne Dis. 2018;55(1):47-51.

Sharma PSR, Kakkar, R Kaore SN, Yadav VK. Geographical distribution, effect of season and life cycle of scrub typhus. JK Sci. 2010;12(2):63-4.

Rapsang AG, Bhattacharyya P. Scrub typhus. Indian J Anaesth. 2013;57(2):127-34.

Rahi M, Gupte MD, Bhargava A, Varghese GM, Arora R. DHR-ICMR Guidelines for Diagnosis and management of Rickettsial diseases in India. Indian J Med Res. 2015; 141(4):417-22.

Jain P, Prakash S, Tripathi PK, Chauhan A, Gupta S, Sharma U, et al. Emergence of Orientia tsutsugamushi as an important cause of acute encephalitis syndrome in India. PLoS Negl Trop Dis. 2018; 12(3):e0006346.

Malik R, Sharma S, Gupta R, Sehgal R. Scrub typhus: a rare cause of encephalitis in Pediatric age group. Pediatr Infect Dis. 2015;7(3):71-3.

Ramyasree A, Kalawat U, Rani ND, Chaudhury A. Seroprevalence of Scrub typhus at a Tertiary care hospital in Andhra Pradesh. Indian J Med Microbiol. 2015;33(1):68-72.

Zhou Y-H, Xia F-Q, Van Poucke S, Zheng M-H. Successful treatment of scrub typhus-associated hemophagocytic lymphohistiocytosis with chloramphenicol: a report of 3 pediatric cases and literature review. Medicine (Baltimore). 2016; 95(8):e2928.

Yu S, Yu X, Zhou B, Liu D, Wang M, Zhang H, et al. Tsutsugamushi disease presenting with aortic valve endocarditis: a case report and literature review. Am J Cardiovasc Dis. 2016; 6(4):185-90.

Rose W, Rajan RJ, Punnen A, Ghosh U. Distribution of Eschar in Pediatric Scrub Typhus. J Trop Pediatr. 2016;27;fmw027.

Chrispal A, Boorugu H, Gopinath KG, Prakash JAJ, Chandy S, Abraham OC, et al. Scrub yphus: an unrecognised threat in South India - clinical profile and predictors of mortality. Trop Doct. 2010;40(3):129-33.

Sarangi R, Pradhan S, Debata N ch, Mahapatra S. Clinical profile of scrub typhus in Children treated in a tertiary care hospital in eastern India. Pediatr Pol. 2016; 91(4):308-11.

Basu S, Saha A, Sarkar S, Sinha MK, Das MK, Datta R, et al. Clinical Profile and Therapeutic Response of Scrub Typhus in Children: A Recent Trend from Eastern India. J Trop Pediatr. 2018;23.

Taylor AJ, Paris DH, Newton PN. A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis. 2015; 9(8):e0003971.

Ganesh R, Suresh N, Pratyusha LL, Janakiraman L, Manickam M, Andal A. Clinical profile and outcome of children with scrub typhus from Chennai, South India. Eur J Pediatr. 2018;177(6):887-90.

Kalal BS, Puranik P, Nagaraj S, Rego S, Shet A. Scrub typhus and spotted fever among Hospitalised children in South India: Clinical profile and serological epidemiology. Indian J Med Microbiol. 2016;34(3):293-8.

Jeong YJ, Kim S, Wook YD, Lee JW, Kim K-I, Lee SH. Scrub typhus: clinical, pathologic, And imaging findings. Radiogr Rev Publ Radiol Soc N Am Inc. 2007;27(1):161-72.






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