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Observational study on clinical profile and outcome of Rickettsial infections in children

Background: Rickettsial diseases are one of the most re-emerging infections of the present time. They are generally incapacitating and difficult to diagnose. Untreated cases can have fatality rates as high as 30-35% but when diagnosed properly, they are often easily treatable. Rickettsial infections are one of the important causes of pyrexia of unknown origin (PUO) and this needs to be differentiated from other febrile illnesses. Rickettsial infections are grossly under- diagnosed in India. Objectives of The Study: To study the clinical profile and outcome of rickettsial infections in children aged less than 12 years Methods: It is a time bound prospective hospital based observational study conducted from 2019 to 2020. All children aged less than 12 years admitted in paediatric ward with fever without an identifiable source of infection and one or more of the following clinical features: rash, oedema, hepatosplenomegaly, Lymphadenopathy, an Eschar and a tick bite or tick exposure were suspected to have rickettsial infection. The purpose of the study was explained to the parents or guardians of the child and an informed consent was taken from them enrolling the child in study group. All suspected cases were subjected to rickettsial IgM/IgG ELISA test and tests to exclude other diseases.All rickettsial IgM/IgG positive cases were followed up through hospital stay and outcomes were noted. Results: The most common age group of presentation was between 1 and 5 yrs. The common symptoms in these children included fever (100%), rash (83.3%), edema of limbs (26.6%), puffiness of face (30%), generalised edema (23.3%), cough (23.3%), pain abdomen (16.6%), vomiting (13.3%), convulsions (10%), headache (3.33%) and arthralgia (3.33%). Signs like Hepatomegaly, facial puffiness, pedal edema, splenomegaly, ecchymosis present in 53.3%, 46.6%, 43.3%, 10% and 6.6% of the cases respectively, mimicking common illnesses. Thus warrants high index of suspicion. SCRUB Typhus and Indian Tick Typus Elisa Positive (mixed infection) noted in 14% of cases. Complications like meningoencephalitis (3.33%), shock (3.33%), DIC (3.33%) was observed in the study. There was good clinical response on initiation of doxycycline within 48hrs of initiation of treatment. Case fatality rate of rickettsial disease in this study was 6.66% (n=2). Conclusion: Indian tick typhus is the most common rickettsial fever noted in this part of Telangana. Rickettsial diseases are difficult to diagnose, unless suspected but treatment is easy, affordable and often successful with dramatic response to antimicrobials.