European Journal of Molecular & Clinical Medicine

Rickettsial diseases are one of the most re-emerging infections of the present time. They are generally incapacitating and difficult to diagnose. Untreated cases can have fatality rates as high as 30-35% but when diagnosed properly, they are often easily treatable. It is a time bound prospective hospital based observational study and All children aged less than 12 years admitted in paediatric ward with fever without an identifiable source of infection and one or more of the following clinical features: rash, oedema, hepatosplenomegaly, Lymphadenopathy, an Eschar and a tick bite or tick exposure were suspected to have rickettsial infection. The most common age group of presentation was between 1 and 5 yrs. The common symptoms in these children included fever (100%), rash 79.4%), edema of limbs (32.4%), puffiness of face (29.4%), generalised edema (20.6%), cough (20.6%), pain abdomen (14.7%), vomiting (11.8%), convulsions (8.8%), headache (2.9%) and arthralgia (2.9%). Signs like Hepatomegaly, facial puffiness, pedal edema, splenomegaly, ecchymosis present in 53.3%, 41.1%, 38.2%, 8.8% and 5.8% of the cases respectively, mimicking common illnesses. Thus warrants high index of suspicion. There is emergence of rickettsial disease in this part of north Karnataka which might have been overlooked earlier due to low index of suspicion.

Rickettsial infections are one of the important causes of pyrexia of unknown origin (PUO) and these needs to be differentiated from other febrile illnesses. Rickettsial infections are grossly under-diagnosed in India. All children aged less than 12 years admitted in paediatric ward with fever without an identifiable source of infection and one or more of the following clinical features: rash, oedema, hepatosplenomegaly, Lymphadenopathy, an Eschar and a tick bite or tick exposure were suspected to have rickettsial infection. All suspected cases were subjected to rickettsial IgM/IgG ELISA test and tests to exclude other diseases. Scrub typhus and Indian tick typhus elisa positive (mixed infection) noted in 14% of cases. Complications like meningoencephalitis (5.8%), shock (5.8%), DIC (2.9%) was observed in the study. There was good clinical response on initiation of doxycycline within 48hrs of initiation of treatment. Case fatality rate of rickettsial disease in this study was 5.8% (n=2). Rickettsial diseases are difficult to diagnose, unless suspected but treatment is easy, affordable and often successful with dramatic response to antimicrobials.