Abstract
Objectives
To report a series of cases of rickettsial infections from central India and to develop a clinical scoring system for its early detection.
Design
Retrospective review of children hospitalized during one year period with fever without a source, and presence of one or more of the clinical features suggestive of rickettsial infection. Diagnosis of rickettsial disease was made by classical clinical features and detection of IgM antibody by ELISA. A clinical scoring system was developed to diagnose spotted fever group by using classical clinical and laboratory findings.
Results
161 patients were admitted and met the inclusion criteria, 75 (45.6%) were diagnosed with rickettsial diseases. 52 (69.3%) had spotted fever group and 23 (30.7%) scrub typhus. The mortality rate with rickettsial diseases was 9%. By using proposed clinical scoring system, a score of 14 has sensitivity and specificity of 96.15% and 98.84%, respectively in making a diagnosis of spotted fever group.
Conclusion
Rickettsial diseases are common in the central part of India and should be included in the differential diagnosis of patients with fever of undetermined source. The proposed scoring system can be used for early detection, treatment and prevention of mortality and morbidity from spotted fever group.
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References
Mahajan SK, Kashyap R, Kanga A, Sharma V, Prasher BS, Pal LS. Relevance of Weil-Felix test in diagnosis of Scrub Typhus in India. J Assoc Phys India. 2006;54:619–621.
Mathai E, Lloyd G, Cherian T, Abraham OC, Cherian AM. Serological evidence of continued presence of human Rickettsiosis in southern India. Ann Trop Med Parasitol. 2001;95:395–398.
Sundhindra BK, Vijaykumar S, Kutti AK. Rickettsial spotted fevers in Kerala. Natl Med J India. 2004;17:51–52.
Kulkarni A, Vaidya S, Kulkarni P, Bidri, LH Padwal S. Rickettsial disease-an experience. Pediatr Infect Dis. 2009;1:118–124.
Shah V, Vaidya V, Bang V, Shah I. Spotted fever in a child in Mumbai, India. J Vector Borne Dis. 2009;4:310–312.
Chapman AS, Bakken JS, Folk SM, Paddock CD, Bloch KC, Krusell A, et al. Diagnosis and management of tickborne rickettsial diseases. MMWR Recomm Rep. 2006;55:1–27.
Rathi N, Rathi A. Rickettsial infections: Indian perspective. Indian Pediatr. 2010;47:157–164.
Siberry GK, Dumler JS. Rickettsial infections. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics, 18th ed. Pennsylvania: Saunders. 2007; p. 1289–1301.
Chugh TD. Emerging and reemerging bacterial diseases in India. J Biosci. 2008;33:549–555.
Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D, Mathai E. Serological evidence for wide distribution of spotted fevers & typhus fever in Tamil Nadu. Indian J Med Res. 2007;126:128–130.
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Rathi, N.B., Rathi, A.N., Goodman, M.H. et al. Rickettsial diseases in central India: Proposed clinical scoring system for early detection of spotted fever. Indian Pediatr 48, 867–872 (2011). https://doi.org/10.1007/s13312-011-0141-7
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DOI: https://doi.org/10.1007/s13312-011-0141-7