Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 6 ( June, 2020 ) > List of Articles

Pediatric Critical Care

Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India

Kamran Zaman, Vijai Williams, Abhay Kumar

Citation Information : Zaman K, Williams V, Kumar A. Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India. Indian J Crit Care Med 2020; 24 (6):445-450.

DOI: 10.5005/jp-journals-10071-23445

License: CC BY-NC 4.0

Published Online: 22-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Introduction: Children with scrub typhus may present with one or more organ failures. Identifying the predictors of severe disease and need for pediatric intensive care unit (PICU) admission would help clinicians during outbreak seasons. Materials and methods: This observational study included 160 children admitted to the emergency department (ED) with scrub typhus confirmed by polymerase chain reaction (PCR) between January 2013 and December 2015. Demographic, clinical, and laboratory data were collected and predictors for PICU admission were identified. Results: There was a seasonal trend with peak presentation in post-monsoon months between August and October. Mean (SD) age at presentation was 6.8 (3.2) years. Fever was present in all with a median (IQR) duration of 9 (6–11) days. Respiratory distress (42%), altered sensorium (24%), hepatomegaly (93%), splenomegaly (57%), and lymphadenopathy (54%) were other features. Rash and eschar were noted in 24% each. Thrombocytopenia (83%), hypoalbuminemia (63%), and hyponatremia (62%) were common laboratory abnormalities. Meningoencephalitic presentation was noted in 29%; acute kidney injury (AKI) (16%), acute respiratory distress syndrome (ARDS) (11%), and myocarditis (3%) were other organ dysfunctions. Sixty-six (41%) children required PICU admission. Intensive care needs include invasive ventilation (n = 27, 17%), vasoactive drugs therapy for hemodynamic support (n = 43, 27%), osmotherapy to treat raised intracranial pressure (n = 27, 17%), and renal replacement therapy (n = 3, 2%). Mortality was 8.8%. On multivariable analysis, lymphadenopathy, respiratory distress, shock, elevated lactate, and meningoencephalitis predicted the requirement of PICU admission. Conclusion: Scrub typhus presents with organ dysfunction during post-monsoon months. We identified predictors of intensive care in children with scrub typhus admitted to ED. Clinical significance: Our results would help clinicians identify severe cases and prioritize resources.


HTML PDF Share
  1. Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JAJ, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India. Trop Doct 2010;40(4):230–234. DOI: 10.1258/td.2010.100132.
  2. Rauf A, Singhi S, Nallasamy K, Walia M, Ray P. Non-respiratory and non-diarrheal causes of acute febrile illnesses in children requiring hospitalization in a tertiary care hospital in North India: a prospective study. Am J Trop Med Hyg 2018;99(3):783–788. DOI: 10.4269/ajtmh.18-0056.
  3. From: The Indian Society of Critical Care Medicine Tropical fever Group, Singhi S, Chaudhary D, Varghese GM, Bhalla A, Karthi N, et al. Tropical fevers: management guidelines. Indian J Crit Care Med 2014;18(2):62–69. DOI: 10.4103/0972-5229.126074.
  4. Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health 2012;5(1):82–88. DOI: 10.1016/j.jiph.2011.11.001.
  5. Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. Indian J Pediatr 2012;79(11):1459–1462. DOI: 10.1007/s12098-012-0721-0.
  6. Kumar Bhat N, Dhar M, Mittal G, Shirazi N, Rawat A, Prakash Kalra B, et al. Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications. Iran J Pediatr 2014;24(4):387–392.
  7. Krishna MR, Vasuki B, Nagaraju K. Scrub typhus: audit of an outbreak. Indian J Pediatr 2015;82(6):537–540. DOI: 10.1007/s12098-014-1664-4.
  8. Kalal BS, Puranik P, Nagaraj S, Rego S, Shet A. Scrub typhus and spotted fever among hospitalised children in South India: clinical profile and serological epidemiology. Indian J Med Microbiol 2016;34(3):293–298. DOI: 10.4103/0255-0857.188315.
  9. Narayanasamy DK, Arunagirinathan AK, Kumar RK, Raghavendran VD. Clinico-laboratory profile of scrub typhus - an emerging rickettsiosis in India. Indian J Pediatr 2016;83(12–13):1392–1397. DOI: 10.1007/s12098-016-2171-6.
  10. Masand R, Yadav R, Purohit A, Tomar BS. Scrub typhus in rural Rajasthan and a review of other Indian studies. Paediatr Int Child Health 2016;36(2):148–153. DOI: 10.1179/2046905515Y.0000000004.
  11. Rose W, Rajan RJ, Punnen A, Ghosh U. Distribution of eschar in pediatric scrub typhus. J Trop Pediatr 2016;62(5):415–420. DOI: 10.1093/tropej/fmw027.
  12. Ganesh R, Suresh N, Pratyusha LL, Janakiraman L, Manickam M, Andal A. Clinical profile and outcome of children with scrub typhus from Chennai, South India. Eur J Pediatr 2018;177(6):887–890. DOI: 10.1007/s00431-018-3143-9.
  13. Singhi S, Rungta N, Nallasamy K, Bhalla A, Peter JV, Chaudhary D, et al. Tropical fevers in Indian intensive care units: a prospective multicenter study. Indian J Crit Care Med 2017;21(12):811–818. DOI: 10.4103/ijccm.IJCCM_324_17.
  14. Kumar V, Kumar V, Yadav AK, Iyengar S, Bhalla A, Sharma N, et al. Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India. PLoS Negl Trop Dis 2014;8(1):e2605. DOI: 10.1371/journal.pntd.0002605.
  15. Sharma N, Biswal M, Kumar A, Zaman K, Jain S, Bhalla A. Scrub typhus in a tertiary care hospital in North India. Am J Trop Med Hyg 2016;95(2):447–451. DOI: 10.4269/ajtmh.16-0086.
  16. Furuya Y, Yoshida Y, Katayama T, Yamamoto S, Kawamura A. Serotype-specific amplification of Rickettsia tsutsugamushi DNA by nested polymerase chain reaction. J Clin Microbiol 1993;31(6):1637–1640. DOI: 10.1128/JCM.31.6.1637-1640.1993.
  17. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6(1):2–8. DOI: 10.1097/01.PCC.0000149131.72248.E6.
  18. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16(5):428–439. DOI: 10.1097/PCC.0000000000000350.
  19. KDIGO-2012-AKI-Guideline-English.pdf [Internet]. [cited 2018 Dec 19]. Available from: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf.
  20. Huang C-T, Chi H, Lee H-C, Chiu N-C, Huang F-Y. Scrub typhus in children in a teaching hospital in eastern Taiwan, 2000-2005. Southeast Asian J Trop Med Public Health 2009;40(4):789–794.
  21. Sirisanthana V, Puthanakit T, Sirisanthana T. Epidemiologic, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr Infect Dis J 2003;22(4):341–345. DOI: 10.1097/01.inf.0000059400.23448.57.
  22. Prakash JAJ, Kavitha ML, Mathai E. Nested polymerase chain reaction on blood clots for gene encoding 56 kDa antigen and serology for the diagnosis of scrub typhus. Indian J Med Microbiol 2011;29(1):47. DOI: 10.4103/0255-0857.76524.
  23. Koraluru M, Bairy I, Varma M, Vidyasagar S. Diagnostic validation of selected serological tests for detecting scrub typhus. Microbiol Immunol 2015;59(7):371–374. DOI: 10.1111/1348-0421.12268.
  24. Lee C-S, Min I-S, Hwang J-H, Kwon K-S, Lee H-B. Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus. BMC Infect Dis 2010;10:216. DOI: 10.1186/1471-2334-10-216.
  25. Hamaguchi S, Cuong NC, Tra DT, Doan YH, Shimizu K, Tuan NQ, et al. Clinical and epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in Northern Vietnam. Am J Trop Med Hyg 2015;92(5):972–978. DOI: 10.4269/ajtmh.14-0806.
  26. Kim D-M, Kang DW, Kim JO, Chung JH, Kim HL, Park CY, et al. Acute renal failure due to acute tubular necrosis caused by direct invasion of Orientia tsutsugamushi. J Clin Microbiol 2008;46(4):1548–1550. DOI: 10.1128/JCM.01040-07.
  27. Varghese GM, Janardhanan J, Trowbridge P, Peter JV, Prakash JAJ, Sathyendra S, et al. Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome. Int J Infect Dis 2013;17(11):e981–e987. DOI: 10.1016/j.ijid.2013.05.017.
  28. Adhikari S, Poudel RS, Shrestha S, Lamichhane P. Predictors of mortality in scrub typhus infection requiring intensive care admission in tertiary healthcare centre of Nepal. Interdiscip Perspect Infect Dis 2018;2018:4867958. DOI: 10.1155/2018/4867958.
  29. Griffith M, Peter JV, Karthik G, Ramakrishna K, Prakash JAJ, Kalki RC, et al. Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission. Indian J Crit Care Med 2014;18(8):497–502. DOI: 10.4103/0972-5229. 138145.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.