Abstract
Background The aim of this study was to describe the clinical profile and atypical presentations of scrub typhus in children aged younger than 12 years admitted to a tertiary care center in south India.
Materials and Methods A retrospective chart review of children diagnosed with scrub typhus from January 2014 to January 2015 was performed; the clinical features (including atypical presentations), laboratory parameters, and response to treatment were analyzed.
Results The majority of the cases was from urban areas and presented with gastrointestinal manifestations (25/31). Eschar was noted in 23 children (74%) and was typically found above the level of the umbilicus. All cases showed a rapid resolution with doxycycline. Atypical presentations included massive lung consolidation, epididymo-orchitis, secondary hemophagocytic lymphohistiocytosis, and “Kawasaki-like” disease. Infants in the group presented with low to moderate grade fever, significant hepatosplenomegaly, high C-reactive protein, and leukocytosis with lymphocytic preponderance. We propose that this tetrad of features, even in the absence of an eschar, should point to a possible diagnosis of scrub typhus in infants.
Conclusion Changes in typical presentation of pediatric scrub typhus present a continuing diagnostic challenge.
Keywords
scrub typhus - eschar - atypical features
