Annals of Tropical Medicine and Public Health
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ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 636-640

Emergence of scrub typhus in Odisha – A hospital based study


Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India

Correspondence Address:
Natabar Swain
Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar - 751 024, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_144_16

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Background: Scrub typhus was unseen in Odisha, but during postmonsoon months of 2014, for the first time, 25 cases of scrub typhus were identified in the pediatric department of Kalinga Institute of Medical Sciences, Bhubaneswar. Objectives: This study aimed at analyzing the demographic pattern, symptomatology, complications, and response to therapy, which will help medical fraternity in early diagnosis and management. Materials and Methods: By retrospective analysis of case records between September 2014 and February 2015, 25 children were found to have scrub typhus by the detection of specific IgM by enzyme-linked immunosorbent assay (ELISA) method. Results: Main clinical manifestations were prolonged fever (100%), respiratory distress (44%), shock, hepatomegaly (96%), splenomegaly (68%), lymphadenopathy (24%), and third spacing (40%). The characteristic eschar was found in 48% children (n = 12). Laboratory findings were leukocytosis (44%), thrombocytopenia (24%), raised C-reactive protein (96%), and transaminitis (76%). All cases were found to be positive for specific IgM by ELISA method (100%). Complications detected were myocarditis (28%), encephalopathy (12%), acute respiratory distress syndrome (4%), and multiorgan dysfunction. Twenty-four cases received doxycycline and all improved, whereas one child who did not get doxycycline expired (died within 24 h of hospitalization). Discussion: Vasculitis is the basic pathogenic mechanism in scrub typhus. An eschar is the most characteristic and pathognomonic feature of scrub typhus but not seen in all patients. If a combination of elevated transaminases, leukocytosis, and thrombocytopenia is found, then specificity and positive predictive value for diagnosis are about 80%. Doxycycline is the drug of choice. Conclusion: Pediatricians and physicians must be aware of scrub typhus for early diagnosis and treatment of this emerging disease.


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