Clinico - Laboratory Profile of Scrub Typhus — An Emerging Rickettsiosis in India
Clinico - Laboratory Profile of Scrub Typhus — An Emerging Rickettsiosis in India
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Clinico - 恙虫病实验室概况 - 印度新出现的立克次体病
DOI：
10.1007/s12098-016-2171-6
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
V. Raghavendran
中科院分区：
文献类型：
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作者：
D. Narayanasamy;A. Arunagirinathan;R. Kumar;V. Raghavendran
目的研究儿童恙虫病在印度南部农村的临床和实验室概况，MethodsThis是一个描述性研究的临床和实验室特征的117名儿童与IgM ELISA证实恙虫病的448名儿童，谁被接纳在儿科病房的三级保健医院，结果117例患儿均出现发热，入院时平均发热时间为9 d。胃肠道是最常见的受影响的系统，见于51%的儿童。咳嗽（82%）、肌痛（70%）、呕吐（68%）、头痛（45%）和腹痛（42%）是恙虫病最常见的症状。恙虫病患儿临床表现以肝肿大（70例）、脾肿大（53%）、面色苍白（50%）和焦痂（41%）为常见.在49例焦痂患儿中，32例伴有区域性淋巴结肿大，常见于腋窝、颈部和腹股沟区。白细胞增多（50%）、贫血（56%）、SGOT / SGPT升高（47%）、血小板减少（41%）、低白蛋白血症（40%）和低钠血症（40%）是常见的实验室特征。休克（46%）、心肌炎（24%）和肺炎（16%）是这些儿童常见的并发症。这项研究表明，早期治疗恙虫病的结果在一个很好的结果，在早期恢复和零mortality.ConclusionsRegional淋巴结肿大是一个标志隐藏或发展焦痂。总计数和分类计数应在发热持续时间的背景下进行解释。由于诊断恙虫病的IgM ELISA可能无法广泛使用，因此任何来自农村地区的发热儿童，如有肝脾肿大、苍白、焦痂、全身/局部淋巴结病、贫血、白细胞增多、血小板减少和天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT）升高，应开始经验性多西环素或阿奇霉素治疗，以防止继发于治疗延迟的危及生命的并发症。
ObjectiveTo study the clinical and laboratory profile of pediatric scrub typhus in rural south India.MethodsThis is a descriptive study of the clinical and laboratory features of 117 children with IgM ELISA proven scrub typhus out of 448 children, who were admitted in the Pediatric ward of a tertiary care hospital, during the study period of November 2014 through March 2015.ResultsFever was present in all 117 children, with mean duration of fever at admission as 9 d. Gastrointestinal tract was the most commonly affected system, seen in 51 % of children. Cough (82 %), myalgia (70 %), vomiting (68 %), headache (45 %) and pain abdomen (42 %) were the most common symptoms of scrub typhus. Hepatomegaly (70), splenomegaly (53 %), pallor (50 %) and eschar (41 %) were the common clinical findings in children with scrub typhus. Out of 49 children with eschar, 32 were associated with regional lymphadenopathy, which was commonly seen in axillary, neck and groin regions. Leucocytosis (50 %), anemia (56 %), increased SGOT / SGPT (47 %), thrombocytopenia (41 %), hypoalbuminemia (40 %) and hyponatremia (40 %) were the common lab features. Shock (46 %), myocarditis (24 %) and pneumonia (16 %) were the common complications seen in these children. This study showed that early treatment for scrub typhus results in a good outcome in terms of early recovery and nil mortality.ConclusionsRegional lymphadenopathy is a marker of hidden or developing eschar. Total count and differential count should be interpreted on the background of the duration of fever. Since IgM ELISA, which is diagnostic of scrub typhus may not be widely available, any febrile child coming from rural area with hepatosplenomegaly, pallor, eschar, generalised / regional lymphadenopathy, anemia, leucocytosis, thrombocytopenia and increased Aspartate transaminase (AST) /Alanine aminotransferase (ALT) should be started on empirical Doxycycline or Azithromycin in order to prevent life threatening complications secondary to delay in therapy.