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

  • Rwituja Thomas St Johns’ Medical College Hospital, Bangalore, India
  • Preeti Puranik St Johns’ Medical College Hospital, Bangalore, India
  • Bhuvanesh Kalal St Johns’ Medical College Hospital, Bangalore, India
  • Carl Britto St Johns’ Medical College Hospital, Bangalore, India
  • Savitha Kamalesh St Johns’ Medical College Hospital, Bangalore, India
  • Sylvan Rego St Johns’ Medical College Hospital, Bangalore, India
  • Anita Shet St Johns’ Medical College Hospital, Bangalore, India
Keywords: rickettsial infections, children, India

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%). Overall 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.

Author Biographies

Rwituja Thomas, St Johns’ Medical College Hospital, Bangalore, India

Intern

Department of Pediatrics

Preeti Puranik, St Johns’ Medical College Hospital, Bangalore, India

Postgraduate

Department of Pediatrics

Bhuvanesh Kalal, St Johns’ Medical College Hospital, Bangalore, India

Postgraduate

Department of Microbiology

Carl Britto, St Johns’ Medical College Hospital, Bangalore, India

Intern

Department of Pediatrics

Savitha Kamalesh, St Johns’ Medical College Hospital, Bangalore, India

Assistant Professor

Department of Microbiology

Sylvan Rego, St Johns’ Medical College Hospital, Bangalore, India

Professor

Department of Pediatrics

Anita Shet, St Johns’ Medical College Hospital, Bangalore, India

Associate Professor

Department of Pediatrics

Published
2016-06-30
How to Cite
1.
Thomas R, Puranik P, Kalal B, Britto C, Kamalesh S, Rego S, Shet A (2016) Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications. J Infect Dev Ctries 10:657-661. doi: 10.3855/jidc.6822
Section
Brief Original Articles