An analysis of clinical presentation and laboratory profile of scrub typhus among pediatric population in a semi urban centre


  • Sathyamoorthy M. Department of Pediatrics, SRM Medical College and Research Centre, Potheri, Kattankulathur 603203, Tamil Nadu, India
  • Subash S. Department of Pediatrics, SRM Medical College and Research Centre, Potheri, Kattankulathur 603203, Tamil Nadu, India
  • Karthikeyan P. Department of Pediatrics, SRM Medical College and Research Centre, Potheri, Kattankulathur 603203, Tamil Nadu, India
  • Prasanna Raju Department of Pediatrics, SRM Medical College and Research Centre, Potheri, Kattankulathur 603203, Tamil Nadu, India



Children, Clinical and laboratory profile, Scrub typhus


Background: Scrub typhus is a re-emerging acute infectious disease caused by Orientia (Rickettsia) tsutsugamushi, in India and globally. Scrub typhus goes undiagnosed at early stages of the illness because many factors like of low index of suspicion, nonspecific signs and symptoms. This study was done to analyse the various clinical demographic factors and their significance in making the clinical diagnosis of scrub typhus and also the analysis of other non-specific laboratory parameters present in the serologically confirmed cases of scrub typhus. The objective of this study was to study the clinical presentation and laboratory profile of scrub typhus in pediatric patients admitted in a tertiary care hospital.

Methods: It was prospective and descriptive study conducted in the pediatric ward of a Medical College Hospital. The study population consisted of 50 children aged 5-15 years having fever of more than 5 days duration. Children with persistent fever with known focus and etiology were excluded from the study.

Results: Among the study group of 50 children, majority were between 5 and 15 years age group. Male children constituted 66% (33 out of 50). Out of 50 children, 94% (47 children) had Eschar.  82% of children did not have any history of tick exposure. Less than 25% of children had Vomiting similar to conjunctival congestion. 94% children had lymphadenopathy and 98% children had mild anemia. 54% children had maculopapular rash and 20% had jaundice. 62% children had hepatomegaly and 96% had splenomegaly. Pedal edema was seen in 22% of cases and anasarca in 2% of cases 76% of children had normal WBC counts, 24% had leucocytosis. Platelet counts of 38,000 to 2,87,000 was noted in the study group and 26% of patients had thrombocytopenia. 98% children had hemoglobin less than 10 gms%. C reactive protein was positive in 96% of cases. Hypoalbuminemia was noted in 48% of children. 60% children were positive for urine albumin.

Conclusions: Scrub typhus should be considered in early part of the illness and patient has to be examined for the presence of Eschar. A clinical diagnosis can be made based on the associated rash, splenomegaly, lymphadenopathy etc. and specific treatment with antimicrobials can be initiated for scrub typhus. 


Tamura A, Ohashi N, Urakami H, Miyamura S. Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen nov, as Orientia tsutsugamushi comb. Int J Syst Bacteriol. 1995;45:589-91.

Watt G, Walker DH. Scrub typhus. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, and Practice. Vol 1. Philadelphia: Churchill Livingstone; 1999:592-597.

Meenakumari PB, Reddy SD, Anoop AR, Bhaskar A. A study of clinical presentation, laboratory findings and outcome among patients of Scrub typhus in General Hospital Thiruvananthapuram. Kerala Med J. 2016;9(2):55-9.

Padbidri VS, Gupta NP. Rickettsiosis in India: A review. J Indian Med Assoc. 1978;71:104-7.

Mahajan SK, Rolainl JM, Sankhyan N, Kaushal RK, Raoultl D. Pediatric Scrub Typhus in Indian Himalayas. Indian J Pediatr. 2008;75(9):947-9.

Digra SK, Saini GS, Singh V, Sharma SD, Kaul R. Scrub Typhus in Children: Jammu Experience. JK Sci J Med Educat Res. 2010;12(2):95-7.

Rathi N, Rathi AN, Goodman MH, Aghal ZH. Rickettsial diseases in Central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr. 2011;48:867-72.

Bhat NK. Scrub typhus in children at a tertiary hospital in North India, clinical profile and complications. Iran J Pediatr. 2014;24(4).

Sankhyan N, Saptharishi LG, Sasidaran K, Kanga A, Singh SC. Clinical profile of scrub typhus in children and its association with hemophagocytic lymphohistiocytosis. Indian Pediar. 2014;5:651-3.

Silva ND, Wijesundara S, Liyanapathirana V, Thevanesam V, Stenos J. Scrub typhus among pediatric patients in dambadeniya: a base hospital in Sri Lanka. Am J Trop Med Hyg. 2012;87(2):342-4.

Huangl CT, Leel HC, Chiul NC, Huangl FY. Scrub typhus in children in a teaching hospital in Eastern Taiwan. 2000-2005 Southeast. Asian J Trop Med Public Health. 2009;40(4):789-94.

Frequently asked questions, Scrub Typhus. World Health Organization, Regional Office for South East Asi. 2010:12.






Original Research Articles