Clinical profile and outcomes of pediatric scrub typhus associated with elevated hepatic transaminases

BACKGROUND

Hepatic transaminase (HT) elevation is frequently seen in children with scrub typhus (ST), but the clinical implication of this common finding is not known.

OBJECTIVE

To describe the clinical profile and outcome of pediatric ST with elevated hepatic transaminase.

METHODS

In this prospective cohort study, all children < 12 years of age presenting with fever for ≥ 5 days and positive immunoglobulin M (IgM) serology for ST were included. Clinical findings, laboratory features and outcomes of children with elevated HT were compared with those who had normal HT.

RESULTS

Of 560 ST positive children included, 257 (45.8%) had associated HT elevation. The common age group affected was 5 to 12 years of age (54.9%). Most of the children came during the second week of fever (68.5%) with mean duration of fever of 9.1 days. The common initial presenting symptoms were cough (77.8%), vomiting (65%) and myalgia (59.1%) and signs were hepatomegaly (64.2%), splenomegaly (57.6%) and generalized lymphadenopathy (54.1%). Eschar was seen in 49.8% of children. Thrombocytopenia (58%) and anemia (49%) were the frequently seen laboratory abnormalities. Severe forms of ST were seen in 45.5% children, of which pneumonia was most common. The fever clearance time (48 ± 19.2 h) and mean duration of hospital stay (6.7 ± 3.3 days) were prolonged in these children. On logistic regression analysis, generalized lymphadenopathy (p = 0.002), ascites (p = 0.037), thrombocytopenia (p < 0.001) and hypoalbuminemia (p = 0.023) were found to be associated with HT elevation in these children.

CONCLUSIONS

Hepatic transaminase (HT) levels increase with the duration of untreated fever and is found to be associated with severe forms of scrub typhus. Children with elevated HT have delay in fever defervescence and their duration of hospital stay was prolonged.

Predictors of Mortality due to COVID-19 Infection among Adults: A Cross-sectional Study

Introduction: Coronavirus diseases 2019 (COVID-19) has emerged as a pandemic with significant mortality risk. The early predictors of mortality in COVID-19 patients are older age, male gender, co-morbidities like uncontrolled diabetes, hypertension, severe asthma, Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease (CKD), Coronary Artery Disease (CAD), Chronic Liver Disease and malignancy and raised pro-inflammatory markers in most of the studies from China, Western Europe and US. Aim: To determine the various risk factors associated with outcomes of COVID-19 infection among laboratory confirmed COVID-19 patients. Materials and Methods: It was a descriptive cross-sectional study involving 420 laboratory confirmed COVID-19 patients, aged 18 years and above, who were admitted in a designated COVID-19 hospital in Puducherry, India. Pretested structured questionnaire was used to collect the data through telephonic interview. Descriptive statistics, frequency, mean and standard deviation was estimated for demographic characteristics as appropriate. Chi-square test was used to investigate demographic and health-related predictors of COVID-19 outcomes. Results: The mean age of the study participants was 41.38 (±17.552) years. Thirty-five (8.3%) patients died during their treatment. The common presenting symptom was fever (142, 33.80%), followed by cough (96, 22.85% each). Factors such as >60 years of age, female gender, patients owning yellow ration card, unemployment, overcrowding, current smoking and alcoholics, attending social gathering, social distancing, hand washing, level of wearing mask were found to be significantly associated with fatal prognosis. Conclusion: Risk factors such as older age, females, unemployment, overcrowding, smoking and alcoholism, co-morbidities, social gathering, social distancing, hand washing and mask usage were found to be associated with COVID-19 deaths.

Adherence to Home Treatment Guidelines Among Pediatric Home Treated COVID-19 Patients in Puducherry

We studied the adherence to Government of India guidelines for home treatment of asymptomatic/mild covid-positive children, whereby a family member is designated as caretaker for the patient. Proportion of caretakers adhering to guidelines was 68%. Persistence in adherence was 6 (1.4) days. 14 children (16.5%) developed symptoms while in home isolation. The most reported commonly barrier was it was that time consuming.

Clinical Profile of Scrub Typhus Meningoencephalitis among South Indian Children

Re-emerging scrub typhus is gaining recognition as an important cause of paediatric meningoencephalitis in tropics. We studied the clinical profile of scrub typhus meningoencephalitis (STME) in children <12 years. Of 270 serology-confirmed cases of scrub typhus, 14 (5%) had features consistent with STME and 9 (64%) of these children were between 5 and 12 years of age; 12 (85%) children presented to the hospital during the second week of illness. Fever, headache and altered sensorium were observed in all children, while meningeal signs, papilledema and seizures were observed in 8 (57%), 7 (50%) and 6 (43%) children, respectively. The mean CSF protein level, glucose level, cell count and percentage of lymphocytes were 75 mg/dl, 46 mg/dl, 41 cells and 86%, respectively. STME should be considered in febrile children from endemic area with neurological features, such as headache or altered sensorium. Lumbar puncture is mandatory to confirm STME and rule out close differential diagnosis, such as pyogenic and tubercular meningitis.

Predictors of Severity in Pediatric Scrub Typhus

OBJECTIVE

To identify the factors that can predict the severity of scrub typhus in children.

METHODS

This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children <12y of age admitted with fever for more than 7d and positive IgM ELISA for scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of 'severe scrub typhus' were identified based on criteria from published adult and pediatric studies.

RESULTS

Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of 'severe scrub typhus' in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the 'severe scrub typhus' cases.

CONCLUSIONS

Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.