Complication profile of scrub typhus and its association with total leucocyte count
Keywords:Children, Leukopenia, Meningoencephalitis, Orientia tsutsugamushi, Scrub typhus
Background: Recent reports from several parts of India indicate that there is a resurgence of scrub typhus. There have been a few studies analysing the association of various complications of scrub typhus with leukocyte count. The objective of this study was to study the association of various complications of scrub typhus with leukocyte count in children.
Methods: A prospective study done at SPMCHI, SMS Medical College, Jaipur from August 2014 to November 2014. 75 Scrub typhus positive children were included in the study group. A detailed history of signs, symptoms, complications, demographic background was taken and relevant laboratory investigations done. The association between the complications of scrub and the total leukocyte count was studied, statistical analysis was done using Chi Square test.
Results: Meningoencephalitis was most commonly seen complication in 14.7% followed by ARDS (9.3%), hepatitis (8%), AKI (6.7%), shock (6.7%) and myocarditis (1.3%). Meningoencephalitis and acute renal failure were more frequent among Scrub Typhus cases with leucopenia (p = 0.006, P = 0.011 respectively). It was observed that hepatitis was more frequent with leukocytosis, but was not statistically significant.
Conclusions: Our study revealed that leukopenia has a significant association with meningoencephalitis and acute kidney injury.
Nelson Textbook of Pediatrics 19th edition, Elsevier Saunders; 2010;221:1025.
Rathi NB, Rathi AN, Goodman MH, Aghai ZH. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr. 2011;48(11):867-72.
Sittiwangkul R, Pongprot Y, Silviliarat S, Oberdorfer P, Jittamala P, et al. Acute fulminant myocarditis in scrub typhus. Ann Trop Paediatr. 2008;28:149-54.
Tsay RW, Chang FY. Acute respiratory distress syndrome in scrub typhus. QJM. 2002;95:126-8.
Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526-33.
Machado MN, Nakazone MA, Maia LN. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Rev Bras Cir Cardiovasc. 2014;29(3):299-307.
Huang CT, Chi H, Lee HC, Chiu NC, Huang FY. Scrub typhus in children in a teaching hospital in eastern Taiwan, 2000-2005. Southeast Asian J Trop Med Public Health. 2009;40:789-94.
Chanta C, Chanta S. Clinical study of 20 children with scrub typhus at Chiang Rai Regional Hospital. J Med Assoc Thai. 2005;88:1867-72.
Silpapojakul K, Chupupakkarn S, Yuthasompob S, Varachit B, Chaipak D, Borkerd T, et al. Scrub and murine typhus in children with obscure fever in the tropics. Pediatr Infect Dis J. 1991;10:200-3.
Bhat NK, Dhar M, Mittal G, Shirazi N. Scrub typhus in children at a tertiary hospital in North India: clinical profile and complications. Iranian J Pediatr. 2014;24(4):387-92.
Kumar M, Krishnamurthy S, Delhikumar CG. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health. 2012;5(1):82-8.
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.
Silpapojakula K, Varachita B, Silpapojakulb K. Paediatric scrub typhus in Thailand: a study of 73 confirmed cases. Trans R Soc Trop Med Hyg. 2004:98(6):354-9.
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.
Murali N, Pillai S, Cherian T, Raghupathy P, Padmini V, Mathai E. Rickettsial infection in south India - how to spot the spotted fever. Indian Pediatr. 2001;38(12):1393-6.
Digra SK, Saini GS, Singh V, Sharma SD, Kaul R. Scrub typhus in children: Jammu experience. JK Science. 2010;12:95-7.
Pavithran S, Mathai E, Moses PD. Scrub typhus. Indian Pediatr. 2004;41(12):1254-7.
Sharma R, Krishna VP, Manjunath, Singh H, Shrivastava S, Singh V, et al. Analysis of two outbreaks of scrub typhus in Rajasthan: a clinico-epidemiological study. J Assoc Physicians India. 2014;62(12):24-9.
Digra SK, Saini GS, Singh V, Sharma SD, Kaul R. Scrub typhus in children in children: Jammu experience. JK Science. 2010;12:95-7.
Kulkarni A, Vaidya S, Kulkarni P, Bidri LH, Padwal S. Rickettsial disease-an experience. Pediatr Infect Dis. 2009;1:118-24.
Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. 2012;5(1):82-8.