Predictors of Severity in Pediatric Scrub Typhus
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To identify the factors that can predict the severity of scrub typhus in children.
This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children <12y of age admitted with fever for more than 7d and positive IgM ELISA for scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of ‘severe scrub typhus’ were identified based on criteria from published adult and pediatric studies.
Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of ‘severe scrub typhus’ in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the ‘severe scrub typhus’ cases.
Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.
KeywordsChildren IgM ELISA Predictors Scrub typhus Severity
DKN: Design, literature search, clinical studies, data analysis, statistical analysis, manuscript preparation, editing and review; TAB: Data acquisition, data analysis, statistical analysis, manuscript editing and review; VV and DK: Literature search, clinical studies, data acquisition, manuscript preparation and editing; SA: Design, literature search, manuscript preparation, editing and will act as guarantor for the paper.
Compliance with Ethical Standards
Conflict of Interest
- 2.Narayanasamy DK, Arunagirinathan AK, Kumar RK, Raghavendran VD. Clinico-laboratory profile of scrub typhus — an emerging rickettsiosis in India. Indian J Pediatr. https://doi.org/10.1007/s12098-016-2171-6.
- 3.Megan E, Reller J, Dumler S. Scrub typhus (Orentiatsutsugamushi). In: Kliegman RM, editor. Nelson Textbook of Paediatrics. Philadelphia: Elsevier; 2016. p. 1504.Google Scholar
- 14.Rose W, Ghosh U, Punnen A, Sarkar R, Prakash JJA, Verghese VP. Comparison of scrub typhus with and without meningitis. Indian J Pediatr. 2017; https://doi.org/10.1007/s12098-017-2403-4.
- 20.Min JK, Jung WC, Baek GH, et al. Intestinal protein loss in patients with tsutsugamushi disease. Korean J Internal Med. 1996;51:457–64.Google Scholar