Clinico-laboratory Profle and Therapeutc Outcome of Serologically Confrmed Scrub Typhus in Children in Tertary Care Children’s Hospital of Nepal Ravindra Kumar Sah 1* , Ram Hari Chapagain 2 , Sushan Man Shrestha 3 and Ganesh Kumar Rai 2 1 Natonal Academy of Medical Sciences (NAMS), Kathmandu, Nepal 2 Department of Pediatrics, Natonal Academy of Medical Sciences (NAMS) and, Kant Children’s Hospital, Nepal 3 Department of Community Medicine, Insttute of Medicine, Tribhuvan University, Nepal * Corresponding author: Ravindra Kumar Sah, MD Resident (Pediatrics) Natonal Academy of Medical Sciences (NAMS), Kathmandu, Nepal, Tel: +9779841675699; E-mail: ravindra.sah1989@gmail.com Received date: July 09, 2018; Accepted date: December 21, 2018; Published date: January 01, 2019 Citaton: Sah RK, Chapagain RH, Shrestha SM, Rai GK (2019) Clinico-laboratory Profle and Therapeutc Outcome of Serologically Confrmed Scrub Typhus in Children in Tertary Care Children’s Hospital of Nepal. Pediatric Infect Dis Vol.4 No.1:1. Copyright: © 2019 Sah RK, et al. This is an open-access artcle distributed under the terms of the Creatve Commons Atributon License, which permits unrestricted use, distributon, and reproducton in any medium, provided the original author and source are credited. Abstract Introducton: Scrub typhus is an acute febrile illness endemic to tsutsugamushi triangle including Nepal. The WHO identfes scrub typhus as a re-emerging disease in South-East Asia. Scrub typhus can have varied manifestatons in children. We aimed to study clinico- laboratory profle and therapeutc outcomes of serologically confrmed scrub typhus in children. Methods: A retrospectve study was conducted at Kant Children’s Hospital, Nepal afer obtaining ethical clearance from Insttutonal Review Commitee, and reviewing the medical records of serologically diagnosed scrub typhus admited to the hospital between August 2016 and January 2018. Relevant data were entered in and analyzed using SPSS 20.0. Results: Children from 9 districts of Nepal severely afected by the 2015 earthquake were admited; mostly from Dhading (14.5%) and Gorkha (9.7%) districts. All 62 children included in the study had a fever; whereas pain abdomen, vomitng, cough, headache, and generalized body swelling were present in 25.8%, 21.0% 24.2%, 14.5%, and 14.5% cases respectvely. Hepatomegaly, splenomegaly, hepatosplenomegaly, lymphadenopathy, and rashes were found in 53.2%, 38.7%, 32.2%, 17.7% and 9.7% cases respectvely. Thrombocytopenia and hyponatremia were seen in 72.6% and 28.6% cases respectvely. The combinaton of hepatosplenomegaly and thrombocytopenia was seen in 29.0%. Azithromycin was used as frst-line treatment in 56 (90.3%) children while other children were treated with doxycycline and chloramphenicol. Seven (11.3%) children required PICU admission. The mean duraton of hospital stay for all children was 6.95 ( ± 2.68) days while it was 9.00 ( ± 3.51) days for children requiring PICU admission. Conclusions: Scrub typhus should be considered in children with an acute febrile illness with hepatosplenomegaly and thrombocytopenia. Azithromycin is the drug of choice. Some children may need intensive care. Keywords: Scrub typhus; Fever; Hepatosplenomegaly; Thrombocytopenia Introducton Scrub typhus is an acute febrile illness caused by obligate intracellular gram-negatve bacterium Orienta tsutsugamushi transmited to rodents (primary host) and humans (accidental host) by the bite of the larval form (chigger) of trombiculid mite (leptotrombidium). Scrub typhus is endemic to a part of the world known as the “tsutsugamushi triangle” which extends from northern Japan and far-eastern Russia in the north to northern Australia in the south and to Pakistan in the west [1]. Nepal is within the “tsutsugamushi triangle” [1]. There were a few atempts to investgate scrub typhus in Nepal, however, there was no clear evidence of apparent outbreak (and fatality) of scrub typhus in Nepal before 2014. Three months afer the devastatng earthquake in Nepal, B.P. Koirala Insttute of Health Sciences (BPKIHS), Dharan had alerted Epidemiology and Disease Control Division (EDCD) that children with fever and severe respiratory features had not been responding to usual course of treatment but later the conditon was confrmed to be scrub typhus and thus outbreak of scrub typhus was ofcially confrmed in Nepal in 2015 [1]. The WHO identfes scrub typhus as a re-emerging disease in South-East Asia with a case fatality rate up to 30% if lef untreated [2]. Scrub typhus can have varied manifestatons and can be mild to severe in children. The disease usually presents as an acute febrile illness with typical eschar, generalized lymphadenopathy, rash and non-specifc symptoms such as fever, headache, myalgia and cough [3]. The disease usually responds dramatcally to antbiotcs but the delay in diagnosis and initaton of appropriate treatment can result in severe complicatons such as acute respiratory distress syndrome, Research Article iMedPub Journals http://www.imedpub.com/ DOI: 10.21767/2573-0282.100065 Pediatric Infectious Diseases: Open Access ISSN 2573-0282 Vol.4 No.1:1 2019 © Under License of Creative Commons Attribution 3.0 License | This article is available from: http://pediatric-infectious-disease.imedpub.com/ 1