G149 Clinical profile and predictors of severity of pediatric scrub typhus in southern india

• Published in: Archives of disease in childhood Vol. 104; no. Suppl 2; p. A61
• Main Authors: Mohammed Umar, M, Elayaraja, S, Mahalakshmi, R
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.05.2019
• Subjects: Children; Cough; Diarrhea; Enzyme-linked immunosorbent assay; Fever; Hemoglobin; Immunoglobulin M; Laboratories; Leukocytosis; Morbidity; Multivariate analysis; Orientia tsutsugamushi; Pain; Pediatrics; Platelets; Scrub typhus; Seizures; Thrombocytopenia; Typhus; Vomiting; India
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-rcpch.145

AimTo study the clinical profile, laboratory parameters and identify the predictors associated with severe scrub typhus in a tertiary care setting in Southern India.MethodsThis retrospective study, conducted in a university teaching hospital, included 235 children aged less than 18 years, admitted between January 2011 to November 2013 and were IgM ELISA positive for Scrub typhus. The clinical, laboratory profile, course and outcome were documented and analysed using univariate analysis. Severe scrub typhus was defined based on the criteria from published adult and pediatric studies. Multivariate analysis was done to analyse the factors associated with severe disease.ResultsOut of 235 children who tested positive (IgM ELISA) for scrub typhus, 39 had severe disease and rest belonged to non-severe group. Most common presenting symptoms and laboratory findings in scrub typhus included Fever >7 days (98.3%), Cough (30.2%), Vomiting(31.1%), Eschar(22.1%), Abdominal pain(20.4%), Anaemia(37.9%), Leukocytosis(44.7%), thrombocytopenia(50.6%), Prolonged PT(40%) and hypoalbuminemia(15.3%).On univariate analysis, following factors correlated with severe disease: PICU stay (OR=9.26, p<0.001, CI=4.24 to 20.20), Altered sensorium (OR=7.35, p=0.016, CI=1.58 to 34.28), Seizures(p<0.001) Diarrhoea (OR=3.16, p=0.021, CI=1.29 to 7.74), Haemoglobin <10 g/dl (OR=2.831, p=0.004, CI=1.40 to 5.72), Platelets<150000 cells/mm (OR=2.54, p=0.014, CI=1.22 to 5.31), SGOT>200 IU (OR=49.7, p<0.001, CI=13.49 to 183.18), Sr. Albumin <2.5 g/dl (OR=3.19, p=0.006, CI=1.43 to 7.11) and prolonged PT >15 (OR=2.23, p=0.031, CI=1.11 to 4.47).Multivariate analysis identified four factors(1)PICU stay (OR=8.54, p<0.001, CI=2.96 to 24.63), (2)Altered sensorium(OR=15.07, p=0.010, CI=1.92 to 118.63), (3)Platelet <1 50 000(OR=3.16, p=0.041, CI=1.05 to 9.47) and (4)SGOT >200 IU (OR=82.64, p<0.001, CI=17.55 to 389.02) to be significantly associated with severe disease.ConclusionThe treating clinician should anticipate severe disease, when scrub typhus children present with seizures, altered sensorium, platelet <1 50 000 and SGOT>200 IU. Close observation and early intervention for such children may prevent severe morbidity and mortality.