Scrub Typhus: A Clinico-Laboratory Differentiation of Children with and without Meningitis.

Neurological involvement in the form of meningitis or meningoencephalitis, although well documented in scrub typhus, has not been extensively studied in the pediatric population. We report the clinical and laboratory profile of 96 children with scrub typhus and compared those with and without meningitis. Twenty seven (28%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), meningeal signs (66.6%), nausea and vomiting (56.3%), seizures (55.5%) and altered sensorium (51.8%). The children with meningitis presented early and had significantly lower respiratory and renal impairments when compared with the non-meningitis group. Cerebrospinal fluid (CSF) analysis revealed elevated total leukocyte count (86.73 ± 94.50 cells/mm(3)), mononuclear pleocytosis (lymphocyte percentage of 76.85 ± 15.86), elevated proteins (108.33 ± 52.63 mg%) and normal CSF glucose (64.18 ± 15.92 mg%). We conclude that meningitis is a common and early complication of childhood scrub typhus. The CSF reveals a lymphocytic pleocytosis, raised proteins and a normal glucose level. These children respond promptly to appropriate antibiotics as do children without meningitis.

Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications.

OBJECTIVE: To study the clinical profile and complications of childhood scrub typhus. METHODS: Prospective observational study of 66 children with scrub typhus, admitted to a tertiary hospital in north India, during the period between January 2011 and December 2012. The diagnosis was confirmed by serology. Findings : All children presented with fever. Other common symptoms were vomiting (56%), facial swelling (52%), cough (35%), abdominal pain (33%), breathlessness (29%) and decreased urine output (29%). High grade fever (>101 (o)F) was recorded in 91% of children. Other common signs were hepatomegaly, splenomegaly, edema, tender lymphadenopathy and hypotension, observed in 82%, 59%, 39%, 38% and 36% of cases, respectively. An eschar and a maculopapular rash each were observed in 20% of patients. Meningoencephalitis (30.3%), severe thrombocytopenia (27.2%), shock (25.8%), acute kidney injury (16.7%) and hepatitis (13.6%) were the most common complications observed in these children. Other common complications were acute respiratory distress syndrome, respiratory failure requiring ventilation, bronchopneumonia and myocarditis. Ninety percent of children became afebrile within 48 hours of initiating an appropriate antibiotic. Median time to defervescence was 22 hours. The overall mortality rate was 7.5%. Causes of death were refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute kidney injury and myocarditis. CONCLUSION: Pediatricians should keep a high index of suspicion for scrub typhus in any febrile child having a maculopapular rash, hepatosplenomegaly, tender lymphadenopathy, thrombocytopenia and features suggestive of capillary leak. Pending serological confirmation, empirical therapy with doxycycline or azithromycin should be started, as delay in treatment would result in life threatening complications.

ENTERIC FEVER - CULTURE AND SENSITIVITY PATTERN AND TREATMENT OUTCOME.

One hundred cases of enteric fever in the age group of 6 months to 12 years were analysed with respect to culture sensitivity pattern and treatment outcome. Patients were divided into 5 treatment groups - chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole + furazolidine, gentamicin + cephalexin and ciprofloxacin. Out of 91 culture positive cases, 100% were sensitive to ciprofloxacin followed by gentamicin (84.9%), cephalexin (83.6%), furazolidine (36.6%), trimethoprim-sulfamethoxazole (34.1%), chloramphenicol (34.0%) and amoxycillin (23.8%). In 60 cases resistant to chloramphenicol, resistance to other drugs varied from 20 to 88.3%. The treatment response was 100% to ciprofloxacin, 72.7% to chloramphenicol, 50% to gentamicin + cephalexin, 38.5% to trimethoprim-sulfamethoxazole + furazolidine and 12.5% to amoxycillin. Out of 48 cases who did not respond to initial regimen, 33 were treated successfully with ciprofloxacin and remaining with other drug regimens. Time taken for defervescence was shortest with gentamicin + cephalexin (4.6±2.0 days) followed by ciprofloxacin (6.1±2.5 days) and chloramphenicol (6.4±3.5 days). There were 3 deaths in this study.

LIPID PROFILE IN NORMAL HEALTHY CHILDREN.

One hundred and fifty healthy children in the age group of 0-12 years were studied to establish normal levels of lipid profile. They were divided into six equal groups viz., newborns, 0-1 year, 1-4 years, 4-7 years, 7-10 years and 10-12 years. The mean values ± SD for total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides were 70 ± 14.48 mg/dl, 35.1 ± 8.04 mg/dl, 23.8 ± 10.62 mg/dl and 50.9 ± 20.77 mg/dl respectively for male neonates and 71.8 ± 13.96 mg/dl, 34.6 ± 6.55 mg/dl, 25.5 ± 9.29 mg/dl and 57.2 ± 18.57 mg/dl respectively for female neonates. These values increased to 158.7 ± 21.23 mg/dl, 60.7 ± 11.70 mg/dl, 80.3 ± 19.26 mg/dl, 86.7 ± 28.80 mg/dl in males and 161.6 ± 23.09 mg/dl 66.7 ± 8.75 mg/dl, 75.8 ± 20.26 mg/dl and 93.2 ± 44.09 mg/dl in females respectively between 10-12 years of age, The various lipid fractions were at the lowest level at birth and increased significantly during first year of life, there after showing a much slower rise in levels. There was no significant difference in values between male and female children.