Hyponatremia: a diagnostic marker for the diagnosis of Rickettsial diseases


  • Channabasavaraj Hullatti Department of Pediatrics, SSIMS and RC, Davangere, Karnataka, India
  • Latha G. S. Department of Pediatrics, SSIMS and RC, Davangere, Karnataka, India
  • Veeresh Babu B. V. Department of Pediatrics, SSIMS and RC, Davangere, Karnataka, India




Hyponatremia, Rickettsial diseases


Background: Rickettsial infections are re-emerging in Indian subcontinent, it is difficult to diagnose among children’s in seasonal conditions, an early recognition with clinical and laboratory findings give good response to treatment and avoid unnecessary investigations in limited resources.

Methods: The case sheets of all 60 children’s aged <18 years were retrieved and reviewed retrospectively, who are both clinically and serologically confirmed as Rickettsial disease cases were included in this study.

Results: Fever for more than 1week was the most common manifestation, followed by splenomegaly (40%), rash (33%), cough (30%), altered sensorium (16%), and seizures (10%). In laboratory investigation Hyponatremia (56%), elevated liver enzymes without significant rise of bilirubin (28%), hypoalbuminemia (28%), and thrombocytopenia (38%). Patients were treated with Doxycycline, Azithromycin. There was no mortality.

Conclusions: Rickettsial infections are notoriously difficult to diagnose in seasonal condition, untreated cases can have fatality as high as 30-35%, when diagnosed, it is easily treated. Majority of case showed Hyponatremia, may be used as marker in limited diagnostic laboratory facilities.  


Khan SA, Dutta P, Khan AM, Topno R, Borah J, Chowdhury P, et al. Re-emergence of scrub typhus in Northeast India. Int J Infect Dis. 2012;16:e88990.

Jayaram Paniker CK. Ananthanarayan and Paniker’s Textbook of Microbiology. 7th ed. University Press Pvt Ltd; 2008:412-421.

Rathi N, Rathi A. Rickettsial infections: Indian perspective. Indian Pediatr. 2010;47:157-64.

Mahajan SK, Rolain JM, Kashyap R, Bakshi D, Sharma V, Prasher BS, et al. Scrub typhus in Himalayas. Emerg Infect Dis. 2006;12:1590-2.

Kelly DJ, Fuerst PA, Ching WM, Richards AL. Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis. 2009;48(3):S203-30.

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

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

Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in Southern India during the cooler months. Ann N Y Acad Sci. 2003;990:359-64.

Huang CT, Chi H, Lee HC, Chiu NC. Scrub typhus in children in teaching hospital in eastern Taiwan, 2000-05, Southeast Asian. J Trop Med Public Health. 2009;40:789-94.

Krishna MR, Vasuki B, Nagaraju K. Scrub typhus: audit of an outbreak. Indian J Pediatrics. 2015;82(6):537-40.

Thomas R, Puranik P, Kalal B, Britto C, Kamlesh 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.

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;34:293-8.






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