Clinical profile, complications and outcome of scrub typhus in children: A hospital based observational study in central Nepal

Scrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children. A prospective obs...

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Vydáno v:	PloS one Ročník 14; číslo 8; s. e0220905
Hlavní autoři:	Pathak, Santosh, Chaudhary, Nagendra, Dhakal, Prativa, Shakya, Disuja, Dhungel, Prativa, Neupane, Gagan, Shrestha, Sandeep, Regmi, Shanti, Kurmi, Om P.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 13.08.2019 Public Library of Science (PLoS)
Témata:	Adolescent Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use Antibiotics Antigens Azithromycin Azithromycin - administration & dosage Azithromycin - therapeutic use Biology and Life Sciences Child Child, Preschool Children Complications Cough Creatinine Demographic aspects Doxycycline Doxycycline - administration & dosage Doxycycline - therapeutic use Drug Therapy, Combination Edema Enzyme-linked immunosorbent assay Enzymes Female Fever Headache Heart diseases Hepatitis Humans Hyponatremia Immunoglobulin M Infant Injury prevention Jaundice Laboratories Liver Lymphadenopathy Lymphatic diseases Male Medicine and Health Sciences Mortality Myalgia Myocarditis Nausea Nepal - epidemiology Observational studies Orientia tsutsugamushi Pain Patient outcomes Pediatric diseases Pediatrics People and Places Prospective Studies Public health Rash Renal function Scrub typhus Scrub Typhus - complications Scrub Typhus - drug therapy Scrub Typhus - parasitology Seizures Seizures (Medicine) Splenomegaly Statistics Teaching hospitals Tertiary Care Centers Thrombocytopenia Treatment Outcome Typhus Urine Vomiting Nepal Canada India
ISSN:	1932-6203, 1932-6203
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Shrnutí:	Scrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children. A prospective observational study was carried out in children aged 1-16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA. All cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%. Scrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0220905