Department of Pediatric Medicine, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), 244, AJC Bose Road, Kolkata, India.
Department of Pharmacology, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), 244, AJC Bose Road, Kolkata, India.
J Trop Pediatr. 2019 Apr 1;65(2):139-146. doi: 10.1093/tropej/fmy027.
The aim of this study was to assess the clinico-laboratory parameters, complications and therapeutic responses in children with scrub typhus in Eastern India.
In this prospective, observational study, all children (age, <12 years) with suspected scrub typhus with a compatible clinical scenario were enrolled consecutively over six months. Cases confirmed by means of a positive IgM serology or a positive Weil-Felix reaction (OXK = 1/80 or above) were administered enteral doxycycline (4.5 mg/kg/day).
Out of 94 recruited children, 61 had confirmed scrub typhus (mean age = 6.1 years, M:F = 1.1:1) with or without complications and having a considerably higher incidence of neurological presentation (meningoencephalistis n = 21, 34.4%). The most frequent manifestations included vomiting (n = 39, 63.9%), abdominal pain (n = 33, 54.1%), lymphadenopathy (n = 36, 59%), hepatosplenomegaly (n = 32, 52.5%), pedal edema (n = 32, 52.5%) and eschar formation (n = 30, 49.2%). Low hemoglobin levels, leukocytosis, thrombocytopenia, hypoalbuminemia, hyponatremia, increased liver enzymes and increased C-reactive protein were associated with delayed defervescence (>48 h).
Scrub meningoencephalitis, with a notably higher incidence, showed favorable therapeutic response. Prompt and empiric doxycycline therapy could be lifesaving.
本研究旨在评估印度东部斑疹伤寒患儿的临床-实验室参数、并发症和治疗反应。
在这项前瞻性观察研究中，连续 6 个月纳入所有（年龄<12 岁）疑似斑疹伤寒且具有相符临床特征的儿童。通过 IgM 血清学阳性或 Weil-Felix 反应（OXK=1/80 或以上）阳性确诊的病例给予肠内多西环素（4.5mg/kg/天）治疗。
在招募的 94 名儿童中，有 61 名患有确诊的斑疹伤寒（平均年龄=6.1 岁，男女比为 1.1:1），伴有或不伴有并发症，且神经表现的发生率明显较高（脑膜炎 n=21，34.4%）。最常见的表现包括呕吐（n=39，63.9%）、腹痛（n=33，54.1%）、淋巴结病（n=36，59%）、肝脾肿大（n=32，52.5%）、足踝水肿（n=32，52.5%）和焦痂形成（n=30，49.2%）。血红蛋白水平降低、白细胞增多、血小板减少、低白蛋白血症、低钠血症、肝酶升高和 C 反应蛋白升高与发热缓解延迟（>48 小时）相关。
斑疹伤寒性脑膜炎的发生率明显较高，但治疗反应良好。及时和经验性多西环素治疗可能是救命的。
