Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Rwituja Thomas, Preeti Puranik, Bhuvanesh Kalal, Carl Britto, Savitha Kamlesh, Sylvan Rego, Anita Shet

Research output: Contribution to journalArticle

Abstract

Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive Weil-Felix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Ove all mortality among hospitalised children was 1.9%. Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.

Original languageEnglish (US)
Pages (from-to)657-661
Number of pages5
JournalJournal of Infection in Developing Countries
Volume10
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

India
Fever
Retinal Vasculitis
Hospitalized Child
Early Diagnosis
Infection
Purpura Fulminans
Scrub Typhus
Growth Disorders
Meningoencephalitis
Thinness
Doxycycline
Adult Respiratory Distress Syndrome
Chloramphenicol
Septic Shock
Exanthema
Meningitis
Malnutrition
Epidemiology
Odds Ratio

Keywords

  • Children
  • India
  • Rickettsial infections

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology
  • Parasitology
  • Virology

Cite this

Five-year analysis of rickettsial fevers in children in South India : Clinical manifestations and complications. / Thomas, Rwituja; Puranik, Preeti; Kalal, Bhuvanesh; Britto, Carl; Kamlesh, Savitha; Rego, Sylvan; Shet, Anita.

In: Journal of Infection in Developing Countries, Vol. 10, No. 6, 01.06.2016, p. 657-661.

Research output: Contribution to journalArticle

Thomas, Rwituja ; Puranik, Preeti ; Kalal, Bhuvanesh ; Britto, Carl ; Kamlesh, Savitha ; Rego, Sylvan ; Shet, Anita. / Five-year analysis of rickettsial fevers in children in South India : Clinical manifestations and complications. In: Journal of Infection in Developing Countries. 2016 ; Vol. 10, No. 6. pp. 657-661.
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T1 - Five-year analysis of rickettsial fevers in children in South India

T2 - Clinical manifestations and complications

AU - Thomas, Rwituja

AU - Puranik, Preeti

AU - Kalal, Bhuvanesh

AU - Britto, Carl

AU - Kamlesh, Savitha

AU - Rego, Sylvan

AU - Shet, Anita

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AB - Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive Weil-Felix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Ove all mortality among hospitalised children was 1.9%. Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.

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