Clinical profile and laboratory parameters of confirmed pediatric scrub typhus cases in a tertiary health care institute


  • Nidhi Chadha Department of Pediatrics, Government Medical College and Hospital, Chandigarh, Punjab, India
  • Roosy Aulakh Department of Pediatrics, Government Medical College and Hospital, Chandigarh, Punjab, India



Orientia, Acute kidney injury, Acute respiratory distress syndrome, Multiorgan dysfunction, Disseminated intravascular coagulation, Hemophagolymphohistiocytosis


Background: Scrub typhus is one of the vector borne tropical infectious disease, caused by O. Tsutsugamushi. Because of nonspecific signs and symptoms and variable prevalence of pathognomic sign (eschar), diagnosis is very difficult in early stage. The purpose of present research was to differentiate that whether case presenting at our institution are different from previously conducted research in various regions.

Methods: Hospital record of all reported cases of scrub typhus admitted to department of pediatrics at tertiary health care institute in North India over last two years (2018-2019) was retrieved and reviewed.

Results: More cases were reported in male. Maximum number of cases were in 5-10 years i.e. 32 (50.0%) and only one case in less than 12 months. Maximum number cases were reported in August to October 53 (82.8%) as shown. Most common presenting complaint was fever. Most of cases reported with fever of duration of 7-14 days in (51.6%). Rash was present in 7 (10.5%) and eschar in 1 (1.5%). In lab parameters reported abnormalities severe hypoalbuminemia, hyperbilirubinemia, elevated transaminases, anemia, thrombocytopenia leucopenia and leucocytosis. Hepatitis in 48 (75%) was most common complication followed by pneumonia. Other reported complications were myocarditis, acute kidney injury, pneumonia, bleeding, meningitis, enchepalopathy , papilledema, ARDS and hemophagocytosis.

Conclusions: Pediatrician should keep high index of suspicion for suspect scrub typhus in a child presents with febrile illness and early treat should be started. Hepatitis is most common complication. As Scrub typhus is associated with multisystem involvement, thorough assessment of patient should be done to look for these complications and appropriate management of complications should be provided to prevent mortality.


Paris DH. Tropical Rickettsial Infections In: Farrar J, Hotez P, Junghanss T, Kang G, Lalloo D, White N, eds. Manson's Tropical Infectious Diseases. 23rd edn. London: W. B. Saunders; 2014:273-91.

Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in South India: a retrospective study. PLoS One. 2013;8(6):e66595.

Chauhan M, Mahajan S, Manish S, Abrol R. Scrub typhus: an emer- ging scourge. Indian J Basic Appl Med Res. 2015;9(4):394-401.

Varghese GM, Trowbridge P, Janardhanan J. Clinical profile and improving mortality trend of scrub typhus in South India. Int J Infect Dis. 2014;23:39-43.

Reller ME, Dumler JS. Scrub typhus (Orientiatsu tsugamushi). In: Kliegman RM, Staton BF, Geme JW, Schor NF, eds. Nelson Text Book of Pediatrics. 19th ed. Philadelphia: Elsevier; 2011:1045-6.

Karki KB, Acharya BP, Dhimal M. Descriptive Epidemiology of Scrub Typhus in Nepal. Nepal Health Res J. 2017;21:12-7.

Bhat NK, Dhar M, Mittal G. Scrub typhus in children at a tertiary hospital in North India: clinical profile and complications. Iran J Pediatr. 2014;24(4):387-92.

Kumar M, Krishnamurthy S, Delhikumar CG, Narayana P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in Southern India: clinical profile and complications. J Inf Public Health. 2012;5(1):82-8.

Sedhain A, Bhattarai GR. Clinical presentation of scrub typhus dur- ing a major outbreak in Central Nepal. Asian J Med Sci. 2017;8 (4):27-31.

Rose W, Rajan R, Punnen A, Ghosh U. Distribution of eschar in pediatric scrub typhus. J Trop Pediatr. 2016;62(5):415-20.

Ren J, Sun J, Wang Z, Feng L, Shi X, Zhang R, et al. Re-emergence of scrub typhus in Zhejiang Province, southern China: A 45-year population-based surveillance study. Travel Med Infect Dis. 2019;32: 101.

KDIGO clinical practice guideline for acute kidney injury. Available at: http://www. practice_guidelines/AKI.php. Accessed on 14 March 2023.

The Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med. 2015;16(5):428-39.

Lo SF. Reference interval for laboratory tests and procedures. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, eds. Nelson Text Book of Pediatrics. India: Elsevier; 2016:3465-71.

Henter JI, Horne A, Arico M, Egeler RM, Filipovich AH, Imashuku S. HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007; 48(2):124-31.

Kumar M, Krishnamurthy S, Kumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at tertiary hospital in southern India: Clinical profile and complications. J Infect Public Health. 2012;5(1): 82-8.

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

Bajracharya L. Scrub Typhus in Children at Tribhuvan University Teaching Hospital in Nepal. Pediatric Health Med Ther. 2020;11:193-202.

Kumar K, Saxena VK, Thomas TG, Lal S. Outbreak investigation of scrub Typhus in Himachal Pradesh (India). J Commun Dis. 2004;36(4):277-83.

Kumar R, Srinivasan P. A study of clinical and laboratory profile of scrub typhus in children in a tertiary hospital in South India. Int J Contemp Pediatr. 2017;4(2):482-5.

Mahajan SK, Rolain JM, Sankhyan N. Pediatric scrub typhus in Indian Himalayas. Indian J Pediatr. 2008; 75(9):947-9.

Murali N, Pillai S, Cherian T. Rickettsial infection in south India - how to spot the spotted fever. Indian Pediatr. 2001;38(12):1393-6.

Joshi R, Punde A, Ohri A. Rickettsial infections seen in rural India. Bombay Hosp J. 2009;51:385-7.

Kamarasu K, Malathi M, Rajagopal V. Serological evidence for wide distribution of spotted fevers & typhus fever in Tamil Nadu. Indian J Med Res. 2007; 126(2):128-30.

Khandelwal S, Meena KJ, Sharma SB. Scrub typhus in children: clinical profile and complications. Ped Oncall. 2015;12(4):23-9.

Sankhyan N, Saptarishi LG, Sasidaran K, Kanga A, Singhi SC. Clinical profile of scrub typhus in children and its association with hemophagocytic lymphohistiocytosis. Indian Pediatr. 2014;51:651-3.

Lee CS, Min IS, Hwang JH. Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus. BMC Infect Dis. 2010;10:216.






Original Research Articles