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Clinical profile and outcomes of pediatric scrub typhus associated with elevated hepatic transaminases

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Abstract

Background

Hepatic transaminase (HT) elevation is frequently seen in children with scrub typhus (ST), but the clinical implication of this common finding is not known.

Objective

To describe the clinical profile and outcome of pediatric ST with elevated hepatic transaminase.

Methods

In this prospective cohort study, all children < 12 years of age presenting with fever for ≥ 5 days and positive immunoglobulin M (IgM) serology for ST were included. Clinical findings, laboratory features and outcomes of children with elevated HT were compared with those who had normal HT.

Results

Of 560 ST positive children included, 257 (45.8%) had associated HT elevation. The common age group affected was 5 to 12 years of age (54.9%). Most of the children came during the second week of fever (68.5%) with mean duration of fever of 9.1 days. The common initial presenting symptoms were cough (77.8%), vomiting (65%) and myalgia (59.1%) and signs were hepatomegaly (64.2%), splenomegaly (57.6%) and generalized lymphadenopathy (54.1%). Eschar was seen in 49.8% of children. Thrombocytopenia (58%) and anemia (49%) were the frequently seen laboratory abnormalities. Severe forms of ST were seen in 45.5% children, of which pneumonia was most common. The fever clearance time (48 ± 19.2 h) and mean duration of hospital stay (6.7 ± 3.3 days) were prolonged in these children. On logistic regression analysis, generalized lymphadenopathy (p = 0.002), ascites (p = 0.037), thrombocytopenia (p < 0.001) and hypoalbuminemia (p = 0.023) were found to be associated with HT elevation in these children.

Conclusions

Hepatic transaminase (HT) levels increase with the duration of untreated fever and is found to be associated with severe forms of scrub typhus. Children with elevated HT have delay in fever defervescence and their duration of hospital stay was prolonged.

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Acknowledgements

We would like to acknowledge all faculty members of the Department of Microbiology, Indira Gandhi Medical College and Research Institute,, Kathirkamam,, Puducherry, for supporting the study with the scrub typhus serology analysis

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Authors and Affiliations

  1. Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Karaikal, 605 006, India

    Dinesh Kumar Narayanasamy

  2. All India Institute of Medical Sciences, Mangalagiri, 522 503, India

    Thirunavukkarasu Arun Babu

  3. Mahatma Gandhi Medical College and Research Institute, Puducherry, 607 402, India

    Jean Fredrick

  4. Indira Gandhi Medical College and Research Institute, Puducherry, 605 009, India

    Devi Kittu

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  1. Dinesh Kumar Narayanasamy
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  2. Thirunavukkarasu Arun Babu
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  3. Jean Fredrick
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  4. Devi Kittu
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Contributions

DKN and TAB conceived the study. DKN, TAB, DK and JF collected data and performed statistical analysis. DKN, DK and JF reviewed the literature and drafted the initial version of the manuscript, which was critically reviewed by TAB. All authors contributed to drafting of the manuscript and approved the final version of the manuscript. TAB shall act as guarantor of the paper.

Corresponding author

Correspondence to Thirunavukkarasu Arun Babu.

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Competing interests

DKN, TAB, JF and DK declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Narayanasamy, D.K., Arun Babu, T., Fredrick, J. et al. Clinical profile and outcomes of pediatric scrub typhus associated with elevated hepatic transaminases. Indian J Gastroenterol 42, 347–354 (2023). https://doi.org/10.1007/s12664-023-01350-y

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