Costs & outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India

Background & objectives: Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. Methods: This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. Results: A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ? 37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ? 128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ? 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Interpretation & conclusions: Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay

Monitoring Weil–Felix test in epidemic retinitis

Purpose: The objective was to study the positivity of the Weil–Felix test (WFT) in epidemic retinitis (ER) during the course of the disease. Methods: This is a retrospective, observational case series of patients diagnosed with ER and presented to a tertiary eye care hospital in south India. Patients with positive WFT at the presentation, and who underwent a follow?up WFT during or after the resolution of ER were studied from September 2019 to March 2022. Patient’s demographics, timings of clinical presentation and resolution, and investigation details with a special focus on WFT positivity and its duration were noted. Results: Sixteen patients were studied. Patients presented after 5 weeks of the fever (range: 2?12 weeks, median: 4). After 1?2 months, WFT was still positive in eight patients (50%). Only in one patient titers increased after 1 month, while in others, the titers decreased (n = 11) or remained the same (n = 4). Repeated tests in those patients (n = 6) after 3?4 months turned negative. Resolution of ER was seen at 1.35 months (range: 1?3 months) after the presentation. The mean duration for WFT to turn negative was 2 months from the presentation (range: 1?4 months) or 3.2 months of the fever (range: 1.5?6 months). Conclusion: In contrast to the reported physician’s observation of increasing titers of WFT after rickettsial fever, ophthalmologists may observe decreasing WFT titers in ER. The clinical resolution of ER may precede the normalization of WFT. Follow?up WFT titers should be studied in larger series in confirmed cases of rickettsial?ER to validate the affordable and readily available WFT in India

Prevalence of rickettsias in ticks (Acari: Ixodidae) collected in domestic animals of the northern region of Caldas department, Colombia / Prevalencia de rickettsias en garrapatas (Acari: Ixodidae) colectadas en animales domésticos del norte del departamento de Caldas, Colombia

ABSTRACT The northern region of the Caldas department in Colombia is considered an endemic area for murine typhus. Recent studies in patients with acute febrile disease demonstrated infection with the spotted fever group's rickettsiae due to an increase in the IgG titer by indirect immunofluorescence in paired sera obtained from these patients. The objective of the current research was to identify the species of ticks present in domestic animals in the northern region of Caldas and establish the presence of rickettsial genomic material in the collected ticks. Ticks were obtained from bovines, horses, and dogs in seven municipalities in the north of Caldas. Ticks were stored in 90 % ethanol until processing and were identified using taxonomic keys, DNA was extracted using commercial techniques, and the gltA gene was amplified by conventional chain reaction polymerase (PCR). Seven hundred thirteen ticks were obtained from 593 domestic animals. The highest infestation occurred in cattle, followed by canines and horses. Ticks found corresponded to the species Riphicephalus microplus, Dermacentor nitens, Amblyomma sp., and Riphicephalus sanguineus s.l. In none of the tick samples, Rickettsia-specific gltA gene DNA was found. It can be inferred that the ticks obtained are not a source of rickettsial infection for people in this department region, despite finding different species associated with the transmission of this disease.

RESUMEN La región norte del departamento de Caldas, Colombia es considerada como una zona endémica de tifo murino. Estudios recientes realizados en pacientes con enfermedad febril aguda, demostraron la infección con rickettsias, del grupo de las fiebres manchadas, debido al aumento en el título de IgG, por inmunofluorescencia indirecta (IFI), en sueros pareados, obtenidos de dichos pacientes. El objetivo de la investigación fue el de identificar las especies de garrapatas presentes en animales domésticos, de la región norte de Caldas y establecer la presencia de material genómico de rickettsias, en las garrapatas recolectadas. En siete municipios, se recolectaron garrapatas de bovinos, de equinos y de caninos. Las garrapatas, se almacenaron en etanol al 90 %, hasta su identificación taxonómica. Se extrajo el ADN, utilizando técnicas comerciales y se amplificó por reacción de cadena de la polimerasa (PCR) convencional el gen gltA. Se obtuvieron 713 garrapatas de 593 animales domésticos. La más alta infestación se presentó en bovinos, seguido de los caninos y equinos. Las garrapatas encontradas correspondieron a las especies Riphicephalus microplus, Dermacentor nitens, Amblyomma sp. y Riphicephalus sanguineus s.l. En ninguna de las muestras, se comprobó la presencia de ADN del gen gltA específico de Rickettsia. Se puede inferir que las garrapatas obtenidas no serían una fuente de infección rickettsial para las personas, en esta región del departamento; sin embargo, su presencia es un factor de riesgo para la adquisición de rickettsiosis asociadas con las fiebres manchadas.

Scrub Typhus with Multiple Cranial Nerve Palsy: A Rare Case Presentation

Scrub typhus, a rickettsial disease endemic in several parts of India, usually presents with acute symptoms. It is caused by small intracellular Gram-negative bacteria belonging to the Rickettsiaceae family. Optic neuritis and lateral rectus palsy may be associated with a range of autoimmune disorders, infectious diseases and raised intracranial tension. In this case, we report optic neuritis and lateral rectus palsy induced by Orientia tsutsugamushi. We report a case of a 23-year-old woman presenting with complaints of high-grade fever, vomiting and generalized swelling since 5 days. During this febrile period, on 4/10/2021, she complained of difficulty in vision and double vision. She was found to be positive for scrub typhus on 5/10/2021. Optic neuritis was diagnosed on the basis of ophthalmologic examination and magnetic resonance imaging (MRI) brain. Investigation was done to rule out autoimmune disorders (vasculitis and connective tissue diseases). Rickettsial optic neuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests. Fever, eschar, history of tick exposure and supportive diagnostic tests usually lead to the diagnosis. This case aims to raise awareness among the healthcare providers for this type of association. Scrub typhus should be included in the differential diagnosis when a patient presents with fever with or without eschar and isolated or multiple cranial nerve palsy

Clinicopathological profile of rickettsial fever in tertiary healthcare centre: a prospective case study

Background: Rickettsia are obligate intracellular proteobacteria spread by eukaryotic vectors like ticks, mites, fleas and lice. Rickettsial infections are generally incapacitating and difficult to diagnose; Case fatality rates up to 45 percent is seen in cases with multiple organ dysfunction. The disease continues to be under diagnosed and treated. Objective of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever. To study the correlation between Rathi-Goodman-Aghai score and Weil-Felix test. To study the response of rickettsial fever to Doxycycline.''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''Methods: This study is a prospective observational study conducted from December 2017 to April 2019 at a tertiary health care center in South India, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. Clinical data and investigations were collected and analysed. The response to doxycycline was recorded.'''''''''''''''''''''''''''''''''''''''''''''''' '''''''''Results: Total of 49 patients were enrolled in the study. Most common age group affected was between 1 to 5 years accounting for 32.7% of the cases. 78% of the patients hailed from rural background. Most common presentation being fever, present in 100% of the cases. 81.6% of patients had significant Rathi-Goodman-Aghai score of >14. Weil felix showed significant titres (1:80) in 97.9% out of which serology suggestive of scrub typhus was found in 79.6% patients. There was no statistical significance between rickettsial score and Weil-Felix test (p value= 0.736). 26.5% of the cases required respiratory support and 2% cases required dialysis. 10.2% cases succumbed and 89.8% cases improved.Conclusions: Rickettsial infection is re-emerging with propensity for life threatening complications. There is no statistical significant correlation between Rickettsial score and Weil Felix test. Early treatment has better outcome.

Molecular confirmation & characterization of Rickettsia conorii in north India: A report of three cases

Background & objectives: In India, spotted fever group rickettsiae (SFGR) are an underdiagnosed cause of acute febrile illness (AFI). The non-specific Weil-Felix test is the first diagnostic modality for the diagnosis of SFGR in many laboratories due to the lack of advanced diagnostic facilities in developing countries. The aim of this study was to detect SFGR using molecular methods in the patients, presenting with AFI in a tertiary care centre in north India. Methods: Consecutive patients (>14 yr of age) with AFI were enrolled over a six month period. Standard investigations for common pathogens causing AFI in India (malaria, dengue, scrub typhus, leptospirosis and enteric fever) were carried out. In patients who were negative for all of the above investigations, blood was subjected to polymerase chain reaction (PCR) targeting outer membrane protein A (ompA) gene of Rickettsia. Results: Of the 51 patients with an undiagnosed aetiology, three were positive by ompA PCR. Two of the PCR products produced good sequences and BLAST identification confirmed them as Rickettsia conorii. The sequences of R. conorii reported from south India clustered with two previously reported novel rickettsial genotypes. The study sequences clustered in a group different from that of Rickettsia spp. of the south Indian sequences reported earlier. Interpretation & conclusions: This study showed the existence of R. conorii in north India. Testing for SFGR may be included in the diagnostic workup of AFI for better disease management.

Draft genomes and reference transcriptomes extend the coding potential of the fish pathogen Piscirickettsia salmonis

Background: Draft and complete genome sequences from bacteria are key tools to understand genetic determinants involved in pathogenesis in several disease models. Piscirickettsia salmonis is a Gram-negative bacterium responsible for the Salmon Rickettsial Syndrome (SRS), a bacterial disease that threatens the sustainability of the Chilean salmon industry. In previous reports, complete and draft genome sequences have been generated and annotated. However, the lack of transcriptome data underestimates the genetic potential, does not provide information about transcriptional units and contributes to disseminate annotation errors. Results: Here we present the draft genome and transcriptome sequences of four P. salmonis strains. We have identified the transcriptional architecture of previously characterized virulence factors and trait-specific genes associated to cation uptake, metal efflux, antibiotic resistance, secretion systems and other virulence factors. Conclusions: This data has provided a refined genome annotation and also new insights on the transcriptional structures and coding potential of this fish pathogen.

Comparison of Scrub Typhus Meningitis with Acute Bacterial Meningitis and Tuberculous Meningitis

Objective: To compare scrub typhus meningitis with bacterial and tuberculous meningitis.Methods: Children aged<15 years admitted with meningitis were screened and those who fitcriteria for diagnosis of scrub typhus meningitis (n=48), bacterial meningitis (n=44) andtuberculous meningitis (n=31) were included for analysis. Clinical features, investigationsand outcomes were compared between the three types of meningitis. Results: Mean age,duration of fever at presentation, presence of headache and, altered sensorium and presenceof hepatomegaly/splenomegaly were statistically significantly different between the groups.Scrub typhus had statistically significant thrombocytopenia, shorter hospital stay and a betterneurological and mortality outcome. Conclusions: Sub-acute presentation of meningitis inolder age group children, and good outcome is associated with scrub typhus when comparedto bacterial and tuberculous meningitis

Status on Rickettsia investigation in Xinjiang / 中华地方病学杂志

The disease caused by Rickettsia is an important zoonotic disease. Due to the complexity of the ecological environment of Xinjiang, the vectors, host and species of Rickettsia are complex and diverse; its natural foci are widely distributed, so they have brought great harm to local human health and livestock production. With global warming, rapid development of social economy and promotion of foreign economic and trade exchanges in Xinjiang, these may become potential factors for the diversity of Rickettsia vectors and hosts. In recent years, some rickettsial disease such as the onset of Q fever, ehrlichiosis and anaplasmosis, are increased at some areas of Xinjiang, thus, the Rickettsia and rickettsial diseases have been widely concerned. At present, a variety of new Rickettsia species have been detected and isolated from several areas of Xinjiang, and their public health significance have also been paid more and more attention. In this paper, we briefly summarized the research status about reported Rickettsia species identification, media host and popular distribution in the Xinjiang region over the past 20 years, to providing scientific basis for a systematic study and diagnosis, prevention and treatment of Rickettsia and rickettsial disease.

Detecção de proteínas imunorreativas de Rickettsia sp. cepa Mata Atlântica / Detection of immunoreactive proteins of Rickettsia sp. Atlantic Forest strain

A Febre Maculosa Brasileira (FMB) é uma doença infecciosa, transmitida por carrapatos ao homem. Uma nova riquetsiose humana foi descrita como causadora de Febre Maculosa no Estado de São Paulo, sendo denominada de Rickettsia sp. cepa Mata Atlântica. O presente trabalho teve como objetivo detectar e identificar proteínas com potencial de estimular o sistema imune de hospedeiro mamífero, desta nova cepa descrita. Para tanto, foi realizado a extração proteica total de Rickettsia sp. cepa Mata Atlântica. As proteínas extraídas foram fracionadas por eletroforese. As bandas proteicas foram transferidas para membranas de nitrocelulose por migração elétrica e submetidas à técnica de Western-blot, para detecção proteica. Ao todo sete proteínas imunorreativas foram detectadas. Duas proteínas apresentaram maior abundancia, com peso molecular, de 200 e 130 kDa respectivamente. Através da comparação de mapas proteômicos existentes e pelo peso molecular que estas proteínas apresentaram, sugere-se que as duas proteínas detectadas representem rOmpA (200 kDa) e rOmpB (130 kDa). As demais proteínas detectadas apresentaram menor ocorrência e peso molecular inferior a 78 kDa, podendo representar membros da família de antígenos de superfície celular (Sca - Surface cell antigen). As proteínas detectadas poderão servir como base de estudo na elaboração de métodos diagnósticos sensíveis e específicos, no desenvolvimento de vacinas, além de possibilitarem novos estudos para terapias mais eficazes.(AU)

Brazilian Spotted Fever (BSF) is an infectious disease transmitted by ticks to humans. A new human rickettsial infection was reported to cause spotted fever in the State of São Paulo and was named Rickettsia sp. Strain Atlantic Forest. This study aimed to detect and identify proteins with potential to stimulate the immune system of mammalian host of this new strain described. Therefore, we performed total protein extraction Rickettsia sp. Strain Atlantic Forest. The extracted proteins were fractionated by electrophoresis. The protein bands were transferred to nitrocellulose membrane by electrical migration and subjected to Western blot for protein detection. In all, seven immunoreactive proteins were detected. Two proteins showed higher abundance, with molecular weight of 200 and 130 kDa respectively. By comparing existing proteomic maps and the molecular weight of these proteins showed that, it is suggested that the two proteins detected representing rOmpA (200 kDa) and rOmpB (130 kDa). The other detected proteins had lower occurrence and molecular weight less than 78 kDa, which may represent members of the cell surface antigens Family (Sca - Surface cell antigen). The detected proteins may serve as a study based on the development of sensitive and specific diagnostic methods in the development of vaccines and they enable further studies to more effective therapies.(AU)

A fatal case of Brazilian spotted fever in a non-endemic area in Brazil: the importance of having health professionals who understand the disease and its areas of transmission

Abstract Brazilian spotted fever (BSF) is caused by the bacterium Rickettsia rickettsii. Because of its high case-fatality rate and apparent increase in areas of transmission, it is considered to be the rickettsial illness of primary public health interest. Cases of this disease have historically occurred in Southeastern Brazil. This article reports the first fatal case of BSF in Southern Brazil. This case high lights the importance of BSF to be considered as a differential diagnosis for acute hemorrhagic fever in areas where cases of BSF may not be expected.

Comparative growth of spotted fever group Rickettsia spp. strains in Vero cells

In Brazil, the spotted fever group (SFG) Rickettsia rickettsii and Rickettsia parkeri related species are the etiological agents of spotted fever rickettsiosis. However, the SFG, Rickettsia rhipicephali, that infects humans, has never been reported. The study of growth dynamics can be useful for understanding the infective and invasive capacity of these pathogens. Here, the growth rates of the Brazilian isolates R. rickettsii str. Taiaçu, R. parkeri str. At#24, and R. rhipicephali HJ#5, were evaluated in Vero cells by quantitative polymerase chain reaction. R. rhipicephali showed different kinetic growth compared to R. rickettsii and R. parkeri.

An update on the epidemiological situation of spotted fever in Brazil

Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. Methods This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. Results In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. Conclusions The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

An update on the epidemiological situation of spotted fever in Brazil

Background Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. Methods This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. Results In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. Conclusions The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.(AU)

An outbreak investigation of scrub typhus in Western Province, Solomon Islands, 2014

OBJECTIVE: To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014. METHODS: An outbreak investigation with a case control study was conducted. A case was defined as an inpatient in one hospital in Western Province, Solomon Islands with high fever (> 38.5 °C) and a negative malaria microscopy test admitted between 1 and 31 May 2014. Asymptomatic controls matched with the cases residentially were recruited in a ratio of 1:2. Serum samples from the subjects were tested for rickettsial infections using indirect micro-immunofluorescence assay. RESULTS: Nine cases met the outbreak case definition. All cases were male. An eschar was noted in five cases (55%), and one developed pneumonitis. We did not identify any environmental factors associated with illness. Serum samples of all five follow-up cases (100%) had strong-positive IgG responses to scrub typhus. All but one control (10%) had a moderate response against scrub typhus. Four controls had low levels of antibodies against spotted fever group rickettsia, and only one had a low-level response to typhus group rickettsia. DISCUSSION: This outbreak represents the first laboratory-confirmed outbreak of scrub typhus in the Western Province of Solomon Islands. The results suggest that rickettsial infections are more common than currently recognized as a cause of an acute febrile illness. A revised clinical case definition for rickettsial infections and treatment guidelines were developed and shared with provincial health staff for better surveillance and response to future outbreaks of a similar kind.

Scrub Typhus Co-infection in an Adolescent Girl with Varicella.

Background: Co-infections with scrub typhus have been described quite frequently in adults but less frequently in children. Case characteristics: An adolescent girl with varicella infection who had persistent fever. Associated clinical features like pain abdomen, vomiting, and features of third space losses made us suspect a co-infection. IgM and IgG antibodies by ELISA in acute and convalescent serum were suggestive of scrub typhus. Outcome: She recovered following a course of oral doxycycline. Message: In unexplained prolonged fever or atypical clinical manifestations not explainable by the primary disease process, coinfection needs to be considered.

Rickettsial diseases in children.

In a tropical country like India, fevers are caused by different etiological agents. Rickettsial infections, which have a global distribution is one of the differential diagnosis in such cases and are reported from almost all parts of India. Rickettsial diseases widely vary in severity from self-limited mild illnesses to fulminating life-threatening infections. They are obligate intracellular gramnegative coccobacillary forms that multiply within eukaryotic cells which makes it difficult to culture them on artificial culture medium. With globalization there is rapid spread of disease across the continents and therefore, skills for diagnosis and management of the disease attains global importance. Rickettsial diseases can be clinically classified as Spotted Fever group, typhus group, distinctive clinical rickettsiae and emerging rickettsiae. The clinical course will have incubation period, stage non-specific clinical signs and symptoms followed by typical/classical features depending on the type of rickettsiae infecting a person. However the clinical manifestation varies from one geographical area to another area for same species. The rickettsial diseases once thought to have been eradicated from India are re-emerging in many parts of our country. Their presence has recently been documented in at least eleven states of our country. Greater clinical awareness, a higher index of suspicion, better use of available diagnostic tools would increase the frequency with which rickettsial diseases are diagnosed.

DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India.

Rickettsial diseases, caused by a variety of obligate intracellular, gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belonging to the Alphaproteobacteria, are considered some of the most covert emerging and re-emerging diseases and are being increasingly recognized. Among the major groups of rickettsioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian tick typhus and Q fever. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45 per cent with multiple organ dysfunction, if not promptly diagnosed and appropriately treated. The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically. Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications and in turn reduces morbidity and mortality due to rickettsial diseases. There is a distinct need for physicians and health care workers at all levels of care in India to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections. Therefore, a Task Force was constituted by the Indian Council of Medical Research (ICMR) to formulate guidelines for diagnosis and management of rickettsial diseases. These guidelines include presenting manifestations, case definition, laboratory criteria (specific and supportive investigations) and treatment.

Clinical Profile of Scrub Typhus in Children and its Association with Hemophagocytic Lymphohistiocytosis.

Objective: To study the clinical profile of children with scrub typhus and its association with hemophagocytic lymphohistiocytosis. Methods: Children presenting with unexplained fever and multi-systemic involvement between May to December 2011 were tested for scrub typhus using IgM ELISA kits. Occurrence of Hemophagocytic lymphohistiocytosis in IgM positive cases of scrub typhus was studied. Results: Of the 35 children with unexplained fever and multi-systemic involvement, 15 children (9 boys) tested positive for scrub typhus. Thrombocytopenia, hypoalbuminemia and raised hepatic transaminases were observed in all children. Out of seven children evaluated for hemophagocytic lymphohistiocytosis. 3 met the criteria for hemophagocytosis. Two children (one with hemophagocytic lymphohistiocytosis) died. Conclusions: Scrub typhus is a common cause of unexplained fever in children in northern India. Hemophagocytic lymphohistiocytosis can occasionally complicate scrub typhus in children.

Study on Clinico -Laboratory Profile of Children with Scrub Typhus.

Scrub typhus is an acute, febrile, infectious illness caused by Orientia (formerly Rickettsia) tsutsugamushi,an obligate intracellular gram-negative bacterium. Humans are accidental hosts in this zoonotic disease.The present retrospective study describes clinical profile of the children hospitalized in hospital with Scrub Typhus infection during period 2010-2011. 19 hospitalized children with clinical features suggestive of Rickettsial disease (fever, generalized rash) who tested ELISA positive for IgM against Scrub Typhus were included in the present study between the age of 1 years and 15 years. All children presented with fever (100%). 42.10% had lymphadenopathy, 47.36% had eschar and 57.89% patients had cough. 26.31, 21.05%, 10.52%, had hepatomegaly, pain abdomen, and respiratory distress and gastrointestinal bleed respectively. All of the children were investigated and treated with as per protocol. None of them died. We think that Rickettsial infection is not quite common in this region but study showed that it is not an uncommon entity and thus, high degree of suspicion, knowledge of geographical distribution and clinical features of Rickettsial disease helps in its early diagnosis and treatment.