Clinical Features and Risk Factors for Critical Cases of Scrub Typhus in 175 Children

Weimin LU; Xiaotao YANG; Ying ZHU; Yi HUANG; Houyu CHEN; Haifeng JIN; Yanchun WANG

doi:10.12259/j.issn.2095-610X.S20220814

Volume 43 Issue 8

Jul. 2022

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Weimin LU, Xiaotao YANG, Ying ZHU, Yi HUANG, Houyu CHEN, Haifeng JIN, Yanchun WANG. Clinical Features and Risk Factors for Critical Cases of Scrub Typhus in 175 Children[J]. Journal of Kunming Medical University, 2022, 43(8): 72-80. doi: 10.12259/j.issn.2095-610X.S20220814

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Clinical Features and Risk Factors for Critical Cases of Scrub Typhus in 175 Children

doi: 10.12259/j.issn.2095-610X.S20220814

1.
School of Clinical Medicine，Dali University，Dali Yunnan 671000
2.
The 2nd department of Infectious Disease，Kunming Children’s Hospital，Kunming Yunnan 650034，China

Received Date: 2021-05-14
Available Online: 2022-07-22
Publish Date: 2022-07-28

Abstract

Abstract

Objective To analyze the clinical manifestations of scrub typhus in children , and the risk factors that may progress to critical cases were discussed, so as to provide a basis for clinicians to diagnose and identify critical patients as soon as possible. Methods The data of scrub typhus patients diagnosed in Kunming Children’s Hospital from 2017 to 2021 were retrospectively analyzed. The subjects were divided into non-critical group and critical group, and the symptoms, signs, laboratory data, treatment and outcome of each group were compared. The indexes with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis, and the receiver operating characteristic curve （ROC） for identifying severe cases was drawn for the indexes that were significant in regression analysis. Results Among the enrolled 175 cases, 145 cases （82.9%） were in the non-critical group and 30 cases （17.1%） in the critical group. There was 2 patients died and other 173 patients were improved or cured after treatment. All the children had fever （100%）, eschar or ulcer were common （85.7%）, followed by hepatomegaly and lymphadenopathy. Compared with the non-severe group, the incidence of cough, edema and hepatomegaly was higher in critical group, and the differences were statistically significant （P < 0.05）. Laboratory tests of all enrolled cases demonstrated that the levels of eosinophils （EOS）, platelet counts （PLT） and albumin （ALB） significantly decreased, and the levels of alanine transaminase （ALT）, aspertate aminotransferase （AST）, lactate dehydrogenase （LDH） , C reactive protein （CRP）, procalcitonin （PCT） increased. Compared with non-critical group, PLT, EOS, ALB and FIBRinogen （FIB） in critical group were decreased （ALL P < 0.05）, ALT, AST, LDH, CRP and PCT in critical group were increased （P < 0.05）, prothrombin time （PT） and partial prothrombin time （APTT） were prolonged （P < 0.05）. Multivariate logistic regression analysis showed that PLT （OR:0.980, 95%CI 0.966～0.994, P < 0.05） and LDH （OR: 1.002, 95%CI 1.000～1.004, P < 0.05） were risk factors for scrub typhus to develop into critical cases. The sensitivity and specificity of PLT and LDH were 89.7% and 76.6% respectively. Conclusion During the epidemic season, clinical manifestations including fever, with or without eschar or ulceration, hepatomegaly, lymphadenopathy and laboratory findings including decresesd EOS, PLT and elevation of ALT, AST and LDH can help the diagnosis of scrub typhus. Decreased PLT and increased LDH are risk factors for the development for critical scrub typhus in children.
- Children’s scrub typhus,
- Clinical features,
- Critical scrub typhus,
- Diagnosis,
- Risk factors

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