Samriti Gupta, MD
Assistant Professor, Pediatrics
All India Institute Of Medical Sciences, Bilaspur, Himachal Pradesh, India
Bilaspur, Himachal Pradesh, India
Disclosure information not submitted.
Juhi Sheekha, MD
Resident
Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
Kangra, Himachal Pradesh, India
Disclosure information not submitted.
Milap Sharma, MD
Professor
Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
Kangra, Himachal Pradesh, India
Disclosure information not submitted.
Title: Clinical profile and risk factors for severe Scrub typhus in children requiring PICU admission
Introduction: Scrub typhus is an important cause of undifferentiated fever with multisystem involvement in children requiring frequent PICU admission in endemic areas. The objectives of the study were to describe the clinical and laboratory characteristics of children with scrub typhus infection requiring PICU admission and to determine the risk factors for the severe infection.
Methods: This was a retrospective chart review from July, 2016-Dec, 2018 of children aged 1 month to 18 years with scrub typhus infection (diagnosed as positive IgM serology by ELISA) admitted in PICU at a tertiary care centre. Data collection included demographic details, clinical features, laboratory investigations, treatment details and outcome. The severity infection was defined as presence of multiorgan dysfunction syndrome (MODS). The data was analysed using STATA 13 version. Descriptive statistics was used to describe the clinical profile and outcomes while risk factors for severe infection were determined by univariate and multivariate analysis.
Results: During the study period, out of 1214 PICU admission, 34 patients (2.8%) were diagnosed with scrub typhus. The mean (SD) age was 11.7 (4.4) years. Fever was present in all the cases. The mean duration of illness was 7.0 (3.3) days. The most common indications for PICU admission were: respiratory distress-19 (65.5%), shock-17 (51.5%), altered sensorium-5 (14.2%) and active bleeding- 3(8.3%). MODS was present in 15 (44.1%) patients. Mortality rate was 5.6%. Gastrointestinal symptoms, respiratory distress, altered sensorium, presence of jaundice, low systolic blood pressure, thrombocytopenia, hyperbilirubinemia, raised liver enzymes, increased blood urea and creatinine, low serum sodium and delayed duration of defervescence were associated with increased risk of MODS in univariate analysis. On multivariate analysis, raised alanine transaminase (OR-1.04, p-0.02), total serum bilirubin (OR-2.24, p-0.05) and hyponatremia (OR-5.43, p-0.04) came out to be independent factors in predictability for development of MODS.
Conclusion: MODS was present in almost half of the children with scrub typhus requiring PICU admission indicating severe scrub typhus infection. Hyperbilirubinemia, raised liver enzymes and hyponatremia were the risk factors for severe scrub typhus infection in children.