Atypical and severe manifestations of scrub typhus in children: Hiding without the rash

Marwah, A.; Marwah, P. M.

Scrub typhus has rarely been reported as a cause of acute febrile illness with Acute Kidney Injury (AKI) and Acute Respiratory Distress Syndrome (ARDS) among children from northern India plains. The diagnostic dilemma is further enhanced when the children do not present with any rash or an eschar. Three such children (12 year old female girl, three year old female child and two year old male child) with severe scrub typhus presenting with AKI, ARDS and multi-organ dysfunction are described in this case series. All were successfully managed with doxycycline and supportive management. This series highlights the importance of early diagnosis and treatment with a low-cost drug like doxycycline based on high index of clinical suspicion and appropriate investigations in a case of paediatric scrub typhus.