Anup Gupta
Assistant Professor, Department of General Medicine, N.C. Medical College & Hospital, Israna, Panipat-132107 (Haryana)
Abstract
Rickettsial diseases are a group of Febrile illnesses caused by obligate intracellular gram-negative coccobacilli and transmitted to man by arthropod vectors., often underdiagnosed due to poor awareness. Rickettsia is obligate intracellular proteobacteria spread by eukaryotic vectors like ticks, mites, fleas, and lice. Rickettsial infections are generally incapacitating and difficult to diagnose; Case fatality rates up to 45 percent are seen in cases with multiple organ dysfunction. The disease continues to be underdiagnosed and treated. The objective of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever. To study the correlation between the Rathi-Goodman-Aghai score and the Weil-Felix test. To study the response of rickettsial fever to Doxycycline.
AIM: The aim of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever.
MATERIAL AND METHOD:
This study is a prospective observational study conducted in the Department of General Medicine. Involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. They were followed up and diagnosed to have a rickettsial fever by Weil-Felix titer of more than 1 in 160. In possible cases, a paired serology was done to further validate the diagnosis of rickettsial infection. The clinical course of the illness and complications of infection were recorded. WHO classification of anemia, 1989 was used for the classification of anemia. Clinical data and investigations were collected and analyzed. The response to doxycycline was recorded in terms of clinical improvement within 2 days. Under the rule and regulation of the institutional ethical committee, signed informed consent was taken from every study subject. Informed written consent was taken from the patients or their guardians willing to participate in the study.
RESULTS:
The total number of rickettsial cases admitted during the study period was forty. The most common age group observed was 1-5 years accounting for 30%. The youngest affected patient was a 2-month-old. Males (50%) were the most commonly affected group in our study. 65% of the patients hailed from a rural background. Fever was the most common symptom present in all the cases enrolled in the study followed by a rash in 23(57%) cases. Eschar though a characteristic feature of rickettsial infection was found in only 3(10%) of the cases. Clinical examination revealed hepatomegaly in 36(91.8%) cases, followed by lymphadenopathy in 11(28.6%) cases, and splenomegaly in 9(22.4%) cases. The response to Doxycycline showed 29(78%) cases improved within 48 hours of the start of treatment.
CONCLUSION:
Any child with undifferentiated fever >5 days, hailing from a rural background; strong suspicion of rickettsial fever to be made. Rathi-Goldman-Aghai score and Weil-Felix test combined together aid in early diagnosis. Early initiation of treatment prevents complications and results in rapid recovery of the patient, hence reducing morbidity and mortality. The outcome isn’t satisfactory in patients for whom delayed initiation of treatment is done. Rickettsial fever poses a significant challenge to any physician, especially in the early course because of its varied clinical presentation.
KEYWORDS: Rathi-Goodman-Aghai score, Response to doxycycline, Rickettsial fever.