Department of Paediatric Medicine, Midnapore Medical College and Hospital, Midnapore, India.
Department of Paediatric Medicine, Dr. B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India.
Sultan Qaboos Univ Med J. 2024 Aug;24(3):375-382. doi: 10.18295/squmj.6.2024.032. Epub 2024 Aug 29.
Scrub typhus is the most common rickettsial disease in India, caused by and transmitted by chigger mites. Previously prevalent in South India, a resurgence of scrub typhus cases has recently affected Eastern India. This study aimed to estimate the prevalence and describe the clinico-laboratory profile of scrub typhus in paediatric patients (1-12 years old) living in Eastern India.
This prospective observational study was conducted from January to December 2019 at the Dr B C Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India. All acute undifferentiated cases of febrile illness, in patients aged between 1-12 years, were tested using scrub typhus serology by ELISA. Demographic details, clinical features, laboratory findings, complications and treatment outcomes of these scrub typhus patients were extracted and analysed.
Out of 1,473 patients with acute febrile illness, 67 (4.5%) children were diagnosed with scrub typhus. The mean age of the selected patients was 5.22 ± 3.05 years, and the majority (64.2%) had been running a fever since the preceding 7-14 days. Gastrointestinal symptoms such as vomiting (43.3%) and abdominal pain (32.8%) were most frequently observed. Major clinical signs of scrub typhus were hepatomegaly (41.8%) and splenomegaly (31.3%). Complications were observed in 74.6% of patients, with thrombocytopenia (40.3%) and meningoencephalitis (29.9%) occurring more frequently. The case fatality rate of the study sample was 1.5%.
Classical eschar was absent in three-fourth of the studied patients. Hence, this study advocates laboratory scrub typhus tests for all suspected cases in the endemic region (Eastern India). Prompt treatment with doxycycline and/or azithromycin could prevent complications such as thrombocytopenia/meningoencephalitis and reduce mortality.
恙虫病是印度最常见的立克次体病，由 引起，通过恙螨传播。该病以前在印度南部流行，最近东部印度也出现了恙虫病病例的回升。本研究旨在评估印度东部地区儿童（1-12 岁）恙虫病的流行率，并描述其临床-实验室特征。
这是一项前瞻性观察研究，于 2019 年 1 月至 12 月在印度加尔各答的 B C 罗伊博士儿科研究生学院进行。对年龄在 1-12 岁之间、患有急性未分化发热病的所有患者进行恙虫病血清学酶联免疫吸附试验（ELISA）检测。提取并分析这些恙虫病患者的人口统计学资料、临床特征、实验室检查结果、并发症和治疗结果。
在 1473 例急性发热性疾病患者中，有 67 例（4.5%）儿童被诊断为恙虫病。入选患者的平均年龄为 5.22 ± 3.05 岁，大多数（64.2%）发热时间为 7-14 天之前。最常观察到的胃肠道症状有呕吐（43.3%）和腹痛（32.8%）。恙虫病的主要临床特征是肝肿大（41.8%）和脾肿大（31.3%）。74.6%的患者出现并发症，血小板减少症（40.3%）和脑膜脑炎（29.9%）更为常见。研究样本的病死率为 1.5%。
四分之三的研究患者没有典型的焦痂。因此，本研究主张在流行地区（印度东部）对所有疑似病例进行实验室恙虫病检测。及时用强力霉素和/或阿奇霉素治疗可以预防血小板减少症/脑膜脑炎等并发症，并降低死亡率。
