Epidemiological and clinical features of scrub typhus in Odisha, Eastern India

Introduction: Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that presents with prolonged fever unless suspected early. The aim of this study was to characterize the epidemiological factors and clinical clues in this region for early diagnosis. Materials and Methods: This study was a retrospective, observational study conducted in all diagnosed scrub typhus cases admitted to the pediatric ward of a tertiary care hospital in-between January 1, 2015 and December 31, 2016. One hundred and one patients admitted with IgM positive for scrub typhus over 2-year period were analyzed for the epidemiological factors and clinical features. Results: Male:female ratio is 1.4:1. The mean age of the patients in our cohort was 4.83 years, ranging from 0.25 to 14 years. Majority (79.2%) was from the rural area. Fever was present in all cases and about 81.19% of children presented with fever for >7 days. Other findings were hepatosplenomegaly (55.45%), respiratory problems (47.54%), abdominal symptoms (40.59%), eschar (26.74%), rashes (15.84%), altered behavior (9.9%) and lymphadenopathy (2.97%) of cases studied. Thrombocytopenia, elevated liver enzymes, and raised C-reactive protein (CRP) were found characteristically. Defervescence after starting doxycycline was within 3.26 ± 2.26 days. Conclusions: Scrub typhus can present in various ways but mostly with prolonged fever. Hepatosplenomegaly, eschar, third spacing, raised CRP, and thrombocytopenia are important clues for early clinical diagnosis. Increased awareness and heightened suspicion, especially in the light of increasing number of patients are required for timely treatment and prevention of complications.