This article is more than 5 years old. Information may no longer be current.
Treatment delays common among children with scrub typhus
Click Here to Manage Email Alerts
Many children in northern Thailand who were infected with scrub typhus were not treated in a timely manner with appropriate antibiotics, according to research published in the Journal of the Pediatric Infectious Diseases Society. Researchers warned that delays in treatment can be potentially fatal.
Tri Wangrangsimakul, BSc(hons), MB, ChB, DTM&H, MRCP, FRCPath, a research physician and a DPhil student at the University of Oxford’s Nuffield Department of Medicine and head of a satellite tropical medicine research unit in Chiangrai, Thailand, and colleagues wrote that at least 13 million square kilometers of the Asia Pacific region is affected by endemic scrub typhus, but recent reports suggest the disease is likely even more widespread.
Wangrangsimakul and colleagues added that children are less likely than adults to have pre-existing immunity to scrub typhus — which is caused by the bacteria Orientia tsutsugamushi and spread through bites of infected chiggers — and they are more likely to develop severe disease as well.
The researchers enrolled 60 febrile pediatric patients with a positive rapid test for scrub typhus and 40 healthy pediatric controls in the Chiang Rai Province in northern Thailand. Their diagnoses were confirmed by PCR or an indirect immunofluorescence assay.
More than half (58%) of all febrile patients had a confirmed scrub typhus diagnosis, and all controls tested negative for infection. The most commonly reported clinical symptoms of scrub typhus among confirmed cases included fever (100%), eschar (60%), cough (60%), tachypnea (46%), lymphadenopathy (43%) and headache (40%). The researchers said only four (11%) patients received appropriate antibiotic treatment for scrub typhus before admission.
The median time to fever clearance was 36 hours (interquartile range [IQR] = 24-53 hours). The researchers observed high rates of complications among the scrub typhus patients, including hepatitis (26%), severe thrombocytopenia (20%), pneumonitis (14%), circulatory shock (11%) and acute respiratory distress syndrome (9%).
Nearly one-quarter of patients (n = 8) had treatment failure, which the researchers defined as failure to defervesce within 72 hours of antibiotic initiation. One of these patients died, according to the researchers. No patients relapsed or were reinfected after admission.
“Antibiotics used in the community and other health care facilities frequently excluded coverage for scrub typhus and other rickettsial diseases, an observation also made in adults,” Wangrangsimakul and colleagues wrote. “As a consequence, effective treatment was delayed in many patients, which might have contributed to the high complication and treatment failure rates in our study. Disease awareness among health care workers and the general population throughout the region must improve.” – by Katherine Bortz
Disclosures: The rapid diagnostic tests used in this study were provided free of charge by the manufacturer, who did not participate in the design or completion of the study, had no access to the study data and was not involved in data analysis or the writing of the manuscript before submission for publication. The authors report no relevant financial disclosures.
Perspective
Back to Top
David H. Walker, MD
A series of strongly documented pediatric cases of scrub typhus calls dramatic attention to this remarkably neglected infectious disease with high and increasing incidence and expanding geographic distribution. This often severe, life-threatening illness is difficult to diagnose clinically, leading to inappropriate antibiotic therapy. Delay in an appropriate antibiotic results in progressive severity and prolonged disease. More basic and translational research is needed to elucidate pathogenesis and immunity and to develop an effective point-of-care diagnostic assay and protective vaccine.
Click Here to Manage Email Alerts