Korean J Pediatr Infect Dis.  2001 Nov;8(2):213-221. 10.14776/kjpid.2001.8.2.213.

A Clinical Study of Tsutsugamushi Fever in Children during 1997~2000 in the Western Kyungnam Province

• Ju HY
• Lee JS
• Kim JH
• Yoo HJ
• Kim CS

• KMID: 2440188
• DOI: http://doi.org/10.14776/kjpid.2001.8.2.213

Abstract

PURPOSE
Tsutsugamushi fever is a acute febrile disease, which is caused by O. tsutsugamushi. Recently, this disease is increasingly reported in children. This study was undertaken to investigate clinical features of tsutsugamushi fever in children.
METHODS
This study involved 17 children with tsutsugamushi fever who were admitted to Masan Samsung hospital between September 1997 and December 2000. We investigated the age, sex ratio, clinical manifestations, laboratory findings, response of therapy and prognosis.
RESULTS
The age of patients was 6.9±3.6 years, ranging from 6 months to 12 years and male predilection(58.8%) was noted and all cases of patients occured in October or November. The most common symptoms were fever in all cases and headache in 8(47.1%). The most common signs were skin rash in all cases, eschar in 14(82.4%) and lymphadenopathy 8(47.1%). Locations of the eschars were back and inguinal area in each 3 cases, neck and chest in each 2, popliteal area in 2, scalp and thigh in each 1. Laboratory findings included anemia in 1 case, leukopenia and thrombocytopenia in each 5, hematuria and proteinuria in each 1, ESR elevation in 2 and positive CRP in 12, AST elevation in 9 and ALT elevation in 7. Serologic diagnosis was made by passive hemagglutination assay(PHA) in 8 cases(47%) on admission, 4 cases in initial negative group were performed follow-up test at 2nd or 3rd weeks of illness and then all cases of 4 were converted to positive reaction. Clinical improvement was noticed in all cases after treatment to chloramhenicol or doxycycline. Mean duration for defervescence after treatment was 1.4±0.8 days. Complications were interstitial pneumonia in 1 case and aseptic meningitis in 3, but all cases of patients were recovered without sequelae or recurrence.
CONCLUSIONS
Tsutsugamushi fever in children was similiar to adult in the clinical features except male predilection. Early diagnosis and empirical treatment based on clinical manifestations such as fever, skin rash, eschar, lymphadenopathy is important and serologic diagnosis need to perform follow-up test at 2nd or 3rd weeks of illness.

Keyword

Tsutsugamushi fever; Children

MeSH Terms

Adult
Anemia
Child*
Clinical Study*
Diagnosis
Doxycycline
Early Diagnosis
Exanthema
Fever
Follow-Up Studies
Gyeongsangnam-do*
Headache
Hemagglutination
Hematuria
Humans
Leukopenia
Lung Diseases, Interstitial
Lymphatic Diseases
Male
Meningitis, Aseptic
Neck
Prognosis
Proteinuria
Recurrence
Scalp
Scrub Typhus*
Sex Ratio
Thigh
Thorax
Thrombocytopenia
Doxycycline