Nallasamy Karthi, Gupta Shalu, Bansal Arun, Biswal Manisha, Jayashree Muralidharan, Zaman Kamran, Williams Vijai, Kumar Abhay
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Crit Care Med. 2020 Jun;24(6):445-450. doi: 10.5005/jp-journals-10071-23445.
Children with scrub typhus may present with one or more organ failures. Identifying the predictors of severe disease and need for pediatric intensive care unit (PICU) admission would help clinicians during outbreak seasons.
This observational study included 160 children admitted to the emergency department (ED) with scrub typhus confirmed by polymerase chain reaction (PCR) between January 2013 and December 2015. Demographic, clinical, and laboratory data were collected and predictors for PICU admission were identified.
There was a seasonal trend with peak presentation in post-monsoon months between August and October. Mean (SD) age at presentation was 6.8 (3.2) years. Fever was present in all with a median (IQR) duration of 9 (6-11) days. Respiratory distress (42%), altered sensorium (24%), hepatomegaly (93%), splenomegaly (57%), and lymphadenopathy (54%) were other features. Rash and eschar were noted in 24% each. Thrombocytopenia (83%), hypoalbuminemia (63%), and hyponatremia (62%) were common laboratory abnormalities. Meningoencephalitic presentation was noted in 29%; acute kidney injury (AKI) (16%), acute respiratory distress syndrome (ARDS) (11%), and myocarditis (3%) were other organ dysfunctions. Sixty-six (41%) children required PICU admission. Intensive care needs include invasive ventilation ( = 27, 17%), vasoactive drugs therapy for hemodynamic support ( = 43, 27%), osmotherapy to treat raised intracranial pressure ( = 27, 17%), and renal replacement therapy ( = 3, 2%). Mortality was 8.8%. On multivariable analysis, lymphadenopathy, respiratory distress, shock, elevated lactate, and meningoencephalitis predicted the requirement of PICU admission.
Scrub typhus presents with organ dysfunction during post-monsoon months. We identified predictors of intensive care in children with scrub typhus admitted to ED.
Our results would help clinicians identify severe cases and prioritize resources.
Nallasamy K, Gupta S, Bansal A, Biswal M, Jayashree M, Zaman K, Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India. Indian J Crit Care Med 2020;24(6):445-450.
恙虫病患儿可能出现一个或多个器官功能衰竭。在疾病暴发季节，识别重症疾病的预测因素以及儿科重症监护病房（PICU）收治需求，将有助于临床医生做出判断。
本观察性研究纳入了2013年1月至2015年12月期间因聚合酶链反应（PCR）确诊为恙虫病而入住急诊科（ED）的160例儿童。收集了人口统计学、临床和实验室数据，并确定了入住PICU的预测因素。
发病呈季节性趋势，8月至10月的季风后月份为发病高峰。就诊时的平均（标准差）年龄为6.8（3.2）岁。所有患儿均有发热，发热持续时间中位数（四分位间距）为9（6 - 11）天。其他症状包括呼吸窘迫（42%）、意识改变（24%）、肝肿大（93%）、脾肿大（57%）和淋巴结病（54%）。皮疹和焦痂的出现率均为24%。血小板减少（83%）、低白蛋白血症（63%）和低钠血症（62%）是常见的实验室异常。29%的患儿有脑膜脑炎表现；其他器官功能障碍包括急性肾损伤（AKI）（16%）、急性呼吸窘迫综合征（ARDS）（11%）和心肌炎（3%）。66例（41%）患儿需要入住PICU。重症监护需求包括有创通气（n = 27，17%）、使用血管活性药物进行血流动力学支持（n = 43，27%）、采用渗透压疗法治疗颅内压升高（n = 27，17%）以及肾脏替代治疗（n = 3，2%）。死亡率为8.8%。多变量分析显示，淋巴结病、呼吸窘迫、休克、乳酸升高和脑膜脑炎是入住PICU的预测因素。
恙虫病在季风后月份会出现器官功能障碍。我们确定了入住ED的恙虫病患儿重症监护的预测因素。
我们的研究结果将有助于临床医生识别重症病例并合理分配资源。
纳拉萨米·K、古普塔·S、班萨尔·A、比斯瓦尔·M、贾亚什ree·M、扎曼·K，《小儿恙虫病入住重症监护病房的临床特征及预测因素：来自印度北部的一项回顾性观察研究》。《印度重症监护医学杂志》2020；24（6）：445 - 450。
