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

J Infect Dev Ctries. 2016 Jun 30;10(6):657-61. doi: 10.3855/jidc.6822.

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.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Demography
  • Female
  • Humans
  • India / epidemiology
  • Infant
  • Male
  • Prevalence
  • Retinal Vasculitis / epidemiology
  • Retinal Vasculitis / pathology
  • Retrospective Studies
  • Rickettsiaceae Infections / complications
  • Rickettsiaceae Infections / epidemiology*
  • Rickettsiaceae Infections / pathology*