PREVALENCE AND CLINICO LABORATORY STUDY OF SCRUB TYPHUS IN PAEDIATRIC PATIENTS ATTENDING A TERTIARY CARE HOSPITAL

P. SAMATHA¹, OBULSU GUNDALA²*
¹Department of Microbiology, Great Eastern Medical School & Hospital, Srikakulum, 532484, Dr NTR University of Health Sciences, Vijayawada, 520008, Andhra Pradesh
²Department of Microbiology, Government Medical College, Ambikapur, Surguja, 497001, Pt. Deendayal Upadhyay Memorial Health Sciences and Ayush University of Chhattisgarh, Atal Nagar, 493661, Chhattisgarh, India
* Corresponding Author : obulesu100@gmail.com

Received : 05-09-2019     Accepted : 26-09-2019     Published : 30-09-2019
Volume : 11     Issue : 9       Pages : 1701 - 1704
Int J Microbiol Res 11.9 (2019):1701-1704

Keywords : Scrub typhus, Eschar, Orientia tsutsugamushi, Enzyme Linked Immunosorbent Assay, Doxycycline, Azithromycin
Academic Editor : Dr Ch Bindukiranmayee, Pattan Ad
Conflict of Interest : None declared
Acknowledgements/Funding : Authors are thankful to Government Medical College, Ambikapur, Surguja, 497001, Pt. Deendayal Upadhyay Memorial Health Sciences and Ayush University of Chhattisgarh, Atal Nagar, 493661, Chhattisgarh, India
Author Contribution : All authors equally contributed

Scrub typhus is a febrile disease caused by Orientia tsutsugamushi (Previously called Rickettsia) and is carried to humans by an arthropod vector of the Trombiculidae family (Leptotrombidium deliense and L. akamushi). Scrub typhus is a Rickettsial infection re-emerging with increased reports from different places in India and other South East Asian countries with considerable mortality and morbidity. Our aim of the present study is to report the magnitude of scrub typhus antibodies and to assess the clinical features and outcomes of paediatric scrub typhus in children attending a tertiary care hospital, Katuri Medical College, Guntur, from August 2014 to February 2017 with differential diagnosis and scrub typhus was diagnosed by positive IgM antibodies against O. Tsutsugamushi. A total of 87 children diagnosed as scrub typhus on the basis of eschar and specific tests were included in the study. They presented with subacute fever 100%, with eschar 29.68% hepatomegaly 36.90%, splenomegaly 45.31%, lymphadenopathy 56.25%, cough 25%, vomiting 48.43%, rigor 100% and Pain abdomen 23%. The counts of blood leucocyte were usually normal but 18.75% of patients exhibited thrombocytopenia. Elevated SGOT /SGPT and bilirubin were seen. There was 96.85% correlation between ELISA and immunochromatographic method. Scrub typhus cases were misdiagnosed due limited awareness of disease and no specific clinical presentation, and lack of proper diagnostic facilities. The clinical features of Scrub typhus mimics with other common infectious conditions, that should be ruled out diagnostically. Both ELISA and Immunochromatography test (ICT) found to be effective in diagnosis. Empirical treatment should be started with Doxycycline and Azithromycin, in suspected cases of Scrub typhus, as the patients responds well to with these antibiotics.

1. Kumar M., Krishnamurthy S., Delhikumar C.G., Narayanan P., Biswal N., Srinivasan S. (2012) J Infect Public Health, 5(1), 82-8.
2. Chakraborty S., Sarma N. (2017) Indian J Dermatol., 62(5), 478-485.
3. Kumar R., Thakur S., Bhawani R., Kanga A., Ranjan A. (2016) J Assoc Physicians India, 64(12), 30-34.
4. Ramyasree A., Kalawat U., Rani N.D., Chaudhury A. (2015) Indian J Med Microbiol., 33(1), 68-72.
5. Ajith Babu, Albin K Mathew, Adhin Antony Xavier, Chidambaranathan S. (2016) International Journal of Healthcare Sciences, 4(1), 321-324.
6. Liu Y.X., Feng D., Suo J.J., Xing Y.B., Liu G., Liu L.H., Xiao H.J., Jia N., Gao Y., Yang H., Zuo S.Q., Zhang P.H., Zhao Z.T., Min J.S., Feng P.T., Ma S.B., Liang S., Cao W.C. (2009) BMC Infect Dis., 9,82.
7. Kulkarni A. (2011) Indian J Pediatr., 78, 81–7.
8. Silpasakorn S., Waywa D., Hoontrakul S., Suttinont C., Losuwanaluk K., Suputtamongkol Y. (2012) J Med Assoc Thai., 95 Suppl 2, S18-22.
9. Saah A.J. (2000) Orientia tsutsugamushi (scrub typhus) In, Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious disease. 5th ed. Philadelphia, Churchill Livingstone; 2000. p. 2056–7.
10. Shanmugapriya V., Anne Sangeetha D., Sowmya Sampath & Kulandai Kasthuri R. (2014) Journal of Vector Borne Diseases, 51(1), 69–70.
11. Kedareshwar P.S., Narvencar, Savio R., Ramnath P., Nevrekar (2012) Indian J Med Res., 136, 1020-4.
12. Oberoi A., Varghese S.R. (2014) Indian J Public Health, 58, 281-3
13. Suntharasaj T., Janjindamai W., Krisanapan S. (1997) J Obstet Gynaecol Res., 23, 75–8.
14. Mahajan S.K., Rolain J.M., Kashyap R., Gupta D., Thakur S., Sharma A., et al. (2009) J Assoc Physicians India, 57, 720–21.
15. Dumler J.S., Siberry G.K. (2007) Scrub Typhus (Orientia tsutsugamushi) In, Kliegman R.M., Behrman R.E., Jenson H.B., Stanton B.F., editors. Nelson Textbook of Pediatrics. Part XVI. 18th ed. Section 11. Ch. 226. Vol. 57. Philadelphia, Saunders, Elsevier; 2007, 2013. pp. 1295–6. 127-34
16. Kalal B.S., Puranik P., Nagaraj S., Rego S., Shet A. (2016) Indian J Med Microbiol., 34(3), 293-8.
17. Gurunathan P.S., Ravichandran T., Stalin S., Prabu V., Anandan H. (2016) Int J Sci Stud., 4, 247–50.
18. Rapsang A.G. and Bhattacharyya P. (2013) Indian journal of anaesthesia, 57(2), 127-134.
19. Rajoor U.G., Shiddappa K Gundikeri, Jayaraj C Sindhur, Dhananjaya M. (2013) Ann Trop Med Public Health, 6(6), 614-617.
20. Das P., Singh D., Das M., Nayak R.K., Mohakud N.K. (2019) Med J DY Patil Vidyapeeth, 12,419-23
21. Sharma S.D., Jamwal A., Tanvi, Saini G. (2015) Journal of Evolution of Medical and Dental Sciences, 4(55), 9545-9552.
22. Narendra Rungta (2014) Indian J Crit Care Med., 18, 489–91.
23. Jain N., Jain V. (2012) J Nepal Paediatr Soc., 32(2), 187-192.
24. Radha Kumar, Purusothaman Srinivasan. (2017) Int J Contemp Pediatr., 4(2), 482-485.
25. Shah I., Bang V.V., Shah V.A. & Vaidya V. (2010) JK Science, 12(2), 88-90.
26. Santanu Deb, Palash Ranjan, Gogoi Richard, Mario Lurshay (2016) J App Med Sci., 4(10), 3714-3720.
27. Gerald G Briggs, Roger K Freeman and Sumner J Yaffe. (2009) Wolters Kluwer/Lippincott Williams & Wilkins. ISBN, 978-0-7817787-6-3. Obstet Med., 2(2), 89.
28. Ananya Ray Laskar, Shivali Suri, Anita Shankar Acharya (2015) J. Commun Dis., 47(3), 19-25.
29. Bhat N.K., Pandita N., Saini M., Dhar M., Ahmed S., Shirazi N., Wasim S., Shirke R., Chandar V. (2016) J Trop Pediatr., 62(3), 194-9.