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Clinical profile and outcome of children with scrub typhus from Chennai, South India

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Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. We prospectively studied the clinico-laboratory profile and outcome of 358 children aged 1 day to 18 years diagnosed with scrub typhus from Chennai, South India. All children (100%) had fever. Eschar was seen in 67%. All children were treated with oral doxycycline and those with complications were treated with intravenous chloramphenicol/azithromycin. Rapid defervescence (within 48 h) after initiation of doxycline was seen in 306 (85%) and 52 (14.5%) developed complications. Multivariate logistic regression analysis revealed that children who had an elevated aspartate amino transferase (> 120 IU/L) and the presence of thrombocytopenia (platelet count less than 1 lac cells/mm3) at admission had high risk of developing complications. The overall mortality rate in this series was 0.8%.

Conclusion: Our 4-year study highlights the clinico-laboratory profile of Scrub typhus in children from Chennai, South India. Early recognition and prompt treatment reduces the complication and mortality.

What is Known:

• Scrub typhus is endemic to tsutsugamushi triangle, a geographical triangle extending from northern Japan in the east to Pakistan and Afghanistan in the west and northern Australia in the south.

• There is paucity of data regarding its clinico-laboratory profile in neonates as well as its predictors of outcome.

What is New:

• Children who had an elevated AST and the presence of thrombocytopenia at admission had high risk of developing complications.

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Aspartate aminotransferase


Acute respiratory distress syndrome


Multi organ dysfunction syndrome


Pediatric intensive care unit


Polymerase chain reaction


Cerebro spinal fluid


White blood cells


  1. Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD (2010) Diagnosis of scrubtyphus. Am J Trop Med Hyg 82(3):368–370

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rahi M, Gupte MD, Bhargava A, Varghese GM, Arora R (2015) DHR-ICMR guidelines for diagnosis & management of Rickettsial diseases in India. Indian J Med Res 141(4):417–422

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rathi N, Kulkarni A, Yewale V (2017) For Indian Academy of Pediatrics Guidelines on Rickettsial diseases in children committee. IAP Guidelines on Rickettsial Diseases in Children. Indian Pediatr 54(3):223–229

    Article  PubMed  Google Scholar 

  4. Jang WJ, Huh MS, Park KH, Choi MS, Kim IS (2003) Evaluation of an immunoglobulin M capture enzyme-linked immunosorbent assay for diagnosis of Orientia tsutsugamushi infection. Clin Diagn Lab Immunol 10:394–398

    PubMed  PubMed Central  CAS  Google Scholar 

  5. Taylor AJ, Paris DH, Newton PN (2015) A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis 9(8):e0003971

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Gurunathan PS, Ravichandran T, Stalin S, Prabu V, Clinical Profile AH (2016) Morbidity pattern and outcome of children with scrub typhus. Int J Sci Stud 4(2):247–250

    Google Scholar 

  7. Narayanasamy DK, Arunagirinathan AK, Kumar RK, Raghavendran VD (2016 Nov) Clinico- laboratory profile of scrub typhus—an emerging rickettsiosis in India. Indian J Pediatr 83(12–13):1392–1397

    Article  PubMed  Google Scholar 

  8. Paris DH, Shelite TR, Day NP, Walker DH (2013) Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg 89(2):301–307

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mahajan SK (2005 Nov) Scrub typhus. J Assoc Physicians India 53:954–958

    PubMed  CAS  Google Scholar 

  10. Wang CL, Yang KD, Cheng SN, Chu ML (1992) Neonatal scrub typhus: a case report. Pediatrics 89:965–968

    PubMed  CAS  Google Scholar 

  11. Aarthi P, Bagyalakshmi R, Mohan KR, Krishna M, Nitin M, Madhavan HN, Kalyani S (2013) First case series of emerging Rickettsial neonatal sepsis identifi ed by polymerase chain reaction-based deoxyribonucleic acid sequencing. Indian J Med Microbiol 31:343–348

    Article  PubMed  CAS  Google Scholar 

  12. Liang XJ, Huang SM, Li JP, Zhu XN, Lu YP, Hocher B, Chen YP (2014) Hepatic impairment induced by scrub typhus is associated with new onset of renal dysfunction. Clin Lab 60(1):63–68

    PubMed  CAS  Google Scholar 

  13. Thomas R, Puranik P, Kalal B, Britto C, Kamalesh S, Rego S, Shet A (2016) Five-year analysis of Rickettsial fevers in children in South India: clinical manifestations and complications. J Infect Dev Ctries 10(6):657–661

    Article  PubMed  Google Scholar 

  14. Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P (2012) Clinical profile of scrub typhus in children. Indian J Pediatr 79(11):1459–1462

    Article  PubMed  Google Scholar 

  15. Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S (2012) Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health 5(1):82–88

    Article  PubMed  Google Scholar 

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Authors and Affiliations



RG: involved in patient management, drafted the manuscript, reviewed the manuscript for intellectual content and will act as guarantor.

NS: involved in patient management and drafted the manuscript.

LLP: collected data, reviewed literature and drafted the mansucript.

LJ: Reviewed literature, involved in patient management and reviewed the manuscript for intellectualcontent.

MM: collected data, reviewed literature and drafted the mansucript.

AA: Reviewed literature, involved in patient management and drafted the manuscript.

Corresponding author

Correspondence to Ramaswamy Ganesh.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies using animals performed by any of the authors. Since all children were subjected to the well proven treatment guidelines and were not required to behave in a certain manner, this research did not require a full review by the Institutional Ethics Committee of Kanchi Kamakoti CHILDS Trust hospital.

Informed consent

Informed consent was obtained from parents of all children who were included in the study.

Additional information

Communicated by Nicole Ritz

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Ganesh, R., Suresh, N., Pratyusha, L.L. et al. Clinical profile and outcome of children with scrub typhus from Chennai, South India. Eur J Pediatr 177, 887–890 (2018).

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