XXXX in rural Rajasthan and a review of other Indian studies.

@entity1 @entity3329 @entity9556 @entity2926 @entity1910 @entity649 @entity3403 @entity828 @entity10 @entity2755 @entity810 @entity311 @entity779 @entity925 @entity221 @entity293
BACKGROUND: @entity9556 is an @entity221 which has been reported from various parts of India with Rajasthan recently joining the list of affected states. AIM: To report a series of paediatric scrub typhus cases from rural Rajasthan. STUDY DESIGN: Retrospective review of @entity1 with scrub typhus admitted to the wards and paediatric intensive care unit (PICU) of a tertiary-care hospital. METHODS: The study was undertaken over an 8-month period from May to December 2013. All @entity1 with a clinical presentation and/or serological confirmation of scrub typhus who tested negative for @entity311 , @entity779 , @entity2926 and @entity293 ( @entity293 ) were included. A range of investigations were undertaken including IgM-ELISA for scrub typhus, followed by appropriate medical management. RESULTS: Thirty @entity1 satisfied the inclusion criteria. The mean (SD, range) age of the @entity1 was 8  56 (3  43, 3-16) years. The most common clinical features were @entity221 (n   =   30, 100%), @entity10 (n   =   20, 66%), @entity925 (n   =   15, 50%), @entity828 (n   =   18, 60%) and pallor (n   =   5, 16%). Typical features such as @entity1910 were observed in only one (3  3%) and three (10%) @entity1 , respectively; none had generalised @entity3329 or conjunctival congestion. IgM-ELISA for scrub typhus was positive in 28 @entity1 (93  3%) and 27 responded to @entity3403 within 24-72hours. One of the three @entity1 who required PICU support responded to intravenous @entity2755 and, of the other two (6  6%), one died of acute @entity649 and the other owing to @entity810 . CONCLUSION: A high index of suspicion is essential for early diagnosis and prevention of complications in scrub typhus together with prompt referral from rural areas to a higher centre. Awareness of the disease manifestations may further help to prevent excessive investigations in @entity1 presenting with non-specific @entity221 and reduce the economic burden to the family and society in resource-constrained settings.
