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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
On Sep 2018




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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case Series
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : SR01 - SR04 Full Version

Neonatal Scrub Typhus- A Series of Five Cases


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/62648.18048
K Vindhiya, A Priya Margaret, LL Prathyusha, S Ramitha Enakshi Kumar

1. Assistant Professor, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. 2. Assistant Professor, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. 3. Consultant, Department of Paediatrics, Ankura Hospital for Women and Child, Hyderabad, Telangana, India. 4. Undergraduate Student, Government Omandura Medical College, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. K Vindhiya,
Assistant Professor, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chennai-600044, Tamil Nadu, India.
E-mail: dr.vindhiya@gmail.com

Abstract

Scrub typhus is a rickettsial infection caused by Orientia tsutsugamushi. This is transmitted by trombiculid mite called chiggers. A number of cases of scrub typhus are being reported from North India. However, there has been a steady increase in the number of cases from Southern India, especially Tamil Nadu, Kerala, and Karnataka. The manifestation of the disease is due to the vasculitis and perivasculitic involvement. This vasculitis is responsible for oedema, skin rash and end organ ischaemic injury. A skin lesion called eschar is pathognomic of this condition, which is present in 40% of the cases. It is a close differential diagnosis for other common infectious diseases like- dengue fever, malaria, enteric fever and severe sepsis. Scrub typhus is rare in neonates. Herewith, the authors reported five cases of neonatal scrub typhus with varied clinical manifestations. All the five neonates (two females and three males) had fever and high C-reactive Protein (CRP), two had hepatosplenomegaly, two presented with shock, one had paralytic ileus, one baby had features of aseptic meningitis and one had pericardial and pleural effusion. Two out of five babies had an eschar, which is pathognomonic of scrub typhus.Three babies were treated with Doxycycline and two babies required Intravenous (i.v.) Azithromycin. All of them recovered completely, except one baby, who succumbed to the illness. A high index of suspicion is required to diagnose scrub typhus in neonates early.Timely intervention will prevent morbidity and mortality.

Keywords

C-reactive protein, Eschar, Fever, Shock, Vasculitis

Rickettsial diseases are amongst the most covert re-emerging infections of recent times (1). They are generally incapacitating and notoriously difficult to diagnose. Untreated cases can have fatality rates, as high as, 30-35% but, when diagnosed properly, they are often easily treated (2). Scrub typhus is one such rickettsial infection, which has been one of the greatest scourges of mankind, occurring in devastating epidemics during times of war and famine. It is caused by Orientia tsutsugamushi transmitted by a trombiculid mite called chiggers (3). It is rare in neonates. As per Ganesh R et al., study the incidence of neonatal scrub typhus was 1.6% (4). During the cooler months of a year, scrub typhus is an important differential diagnosis of other common infections during that period like dengue, malaria and enteric fever. When diagnosed, the treatment is simple and effective, with significant improvement in the suffering child, soon after starting the treatment (5). There is a definitive need to have knowledge about geographical distribution and clinical features of scrub typhus which helps in its early diagnosis and treatment. There are very few reports available on scrub typhus in neonates. The authors hereby, report five cases of neonatal scrub typhus.

Case Report

Case 1

A 15-day-old male neonate, first born to a non consanguineous marriage was admitted with fever, rash with abdominal distension for two days. The neonate was apparently well two days back and developed fever-100.8oF. The baby was exclusively on breast feed with no significant past history. Antenatal history was uneventful. On examination, the neonate was haemodynamically stable had maculopapular rash- eschar over the right-side of the back below the chest. (Table/Fig 1). The baby also had moderate haepatomegaly 5-6 cm of liver and 3-4 cm of spleen. A diagnosis of scrub typhus was made and a differential diagnosis of sepsis was given. Investigations revealed a normal Complete Blood Count (CBC) with a high CRP (100.4 mg/L). Liver Function Test (LFT) showed an elevated Serum Glutamic-oxaloacetic Transaminase (SGOT)/Serum Glutamic pyruvic Transaminase (SGPT)-220/304 IU/L Ultrasound abdomen showed hepatosplenomegaly. Scrub IgM Enzyme-Linked Immunosorbent Assay (ELISA) was positive. So, a diagnosis of neonatal scrub typhus was made. The baby was treated with appropriate fluids and doxycycline for two days and he recovered completely. The baby was clinically well on follow-up.

Case 2

An 18-day-old female baby, second born to non consanguineous parents was brought with fever, breathlessness, lethargy and refusal of feeds for one day. The baby was exclusively on breast feed. Antenatal history was uneventful. On examination, the baby was febrile with a temperature of 101oF, and had generalised maculopapular rash (Table/Fig 2) with hepatosplenomegaly, baby was haemodynamically unstable with a heart rate of 180 Beats Per Minute (BPM) with cold peripheries and a capillary refill time more than five seconds. Baby had hypotensive shock with respiratory failure. A provisional diagnosis of dengue with septic shock was made. A differential diagnosis of sepsis and scrub typhus were given. Investigations showed a normal CBC and elevated CRP (141 mg/L). There Prothrombin Time (PT) was 42 seconds and a Partial Thromboplastin Time (PTT) was 75 seconds, both of which were prolonged. Ultrasound abdomen showed hepatosplenomegaly. Dengue serology was negative. Scrub IgM ELISA was positive. Echocardiogram (ECHO) showed pericardial effusion with Left Ventricular (LV) dysfunction. A final diagnosis of scrub typhus with shock was made. The baby was started on empirical antibiotics and i.v. Azithromycin as per the Neonatal Intensive Care Unit (NICU) protocol. Baby succumbed to illness within 48 hours of admission.

Case 3

A 22-day-old female baby, first born to non consanguineous parents was brought with complaints of fever and lethargy of two days duration. There was history of pregnancy induced hypertension in the antenatal period in the mother. Baby was on breast feed and artificial feed. On examination, the neonate had features of shock in the form of feeble distal pulses, cold peripheries and a capillary refill time of six seconds. The baby was tachycardic with a heart rate of 186 BPM. There was no rash. There was mild hepatosplenomegaly.The baby was admitted in NICU and required mechanical ventilation in view of worsening shock. A provisional diagnosis of dengue septic shock was made and a differential diagnosis of scrub typhus with shock was given. CBC showed thrombocytopenia and elevated CRP (114 mg/L). Chest X-ray showed bilateral pleural and pericardial effusion (Table/Fig 3). Intercostal drainage was done for pleural effusion, ECHO showed pericardial effusion with LV dysfunction. Ultrasound showed free fluid with hepatosplenomegaly. Dengue serology was negative and scrub IgM ELISA was positive. A final diagnosis of scrub typhus with shock was made. The baby was treated with doxycycline and other supportive measures. The baby improved and did not require any pericardiocentesis.

Case 4

A 24-day-old male neonate, first born to non consanguineous parents was brought with complaints of fever, abdominal distension 2and lethargy for three days. The neonate was normal three days back after which he developed a fever of 102oF, with abdominal distension and lethargy. There was no history of bad child rearing practices like vasambu ingestion, nose blowing or administration of honey water and artificial feeds. The baby was exclusively on breast feed. There was a history of travel to the native village prior to onset of symptoms. Antenatal history was insignificant. On examination, the baby had abdomen distension with absent bowel sounds suggestive of paralytic ileus. He also had hepatosplenomegaly 5-6 cm liver and 3-4 cm spleen. A provisional diagnosis of sepsis was made. The baby was started on broad spectrum antibiotics. CBC showed thrombocytopenia with high CRP (90 mg/L). X-ray abdomen showed dilated bowel loops (Table/Fig 4). Scrub IgM ELISA was positive and a final diagnosis of scrub typhus with paralytic ileus was made. Baby was kept Nothing by mouth (NPO) and i.v. azithromycin was added. After 48 hours, baby was gradually started on enteral feeds which the baby tolerated well. The baby was discharged after seven days of i.v. Azithromycin and was doing well on follow-up.


Case 5

A 27-day-old male neonate, second born to non consanguineous marriage was brought with fever for one day associated with vomiting and seizures.The baby was apparently normal two days back after he developed fever and vomiting followed by one episode of seizures in the form of apnea and unresponsiveness, which lasted for less than three minutes. In the antenatal period, mother had gestational diabetes and was on meal diet plan. The baby cried immediately after birth and there was no NICU admission. On examination, baby was irritable. Anterior fontanelle was full, fundus examination was normal. An eschar was noted over the right ear (Table/Fig 5). A probable diagnosis of scrub typhus was made in view of pathognomonic eschar. Baby was admitted in NICU and there was no furthur seizures. Investigations showed normal CBC with elevated CRP (105 mg/L). Cerebrospinal Fluid (CSF) examination was suggestive of aseptic meningitis. Scrub IgM ELISA was positive and the final diagnosis of scrub typhus with aseptic meningitis was made. The baby was treated with i.v. Azithromycin. Baby recovered completely and was doing well on follow-up.

Summary of the five cases of neonates with scrub typhus has been elaborated in (Table/Fig 6).

Discussion

Scrub typhus in neonates is not very different from older children. The clinical features like fever and hepatosplenomegaly which are common in children were present in three babies although, eschar was seen in two of them. High degree of suspicion is vital in diagnosing the disease in neonates. In the present case series, two babies were suspected because of gross organomegaly (5-6 cm of liver and 3-4 cms of spleen), one was because of maculopapular rash with prolonged fever and hailing from epidemic area, two babies were suspected because of pericardial effusion found in echocardiography. Investigations revealed White Blood Cells (WBC) count in normal range (5/5, 100%), and thrombocytopenia (2/5, 40%). CRP was high in all five babies. Blood and urine cultures were sterile in all babies. All of them had ELISA positive for IgM against scrub typhus. Two babies presented with hypotensive shock and one baby had aseptic meningitis. All five babies were initially started on empirical antibiotics as per the NICU protocol. After diagnosing scrub typhus, two of them received doxycycline and three of them were treated with i.v. Azithromycin. One baby died within 48 hours of admission and other four babies recovered from the illness. There are very few reports available on scrub typhus in neonates (Table/Fig 7) (1),(4),(6),(7),(8),(9),(10),(11),(12),(13).

Orientia tsutsugamushi causes scrub typhus, which is the most common rickettsial infection. The infection is transmitted by the bite of an infected mite chigger. Srcub typhus is prevalent in North India and is emerging in Southern parts of India especially, in Tamil Nadu and Andhra Pradesh (14). It causes perivascular inflammation leading to vasculitis. This results in vascular leak and end-organ injury. It can affect people of any age from neonates, children, adults and pregnant women. In pregnancy, it can lead to intrauterine death, premature delivery, and small for gestational age infants (15). It has an incubation period of 6 to 21 days. It can present with non specific clinical features like fever, myalgia, and lethargy. It can involve any system ranging from respiratory distress, abdominal distension, shock, pericardial-pleural effusion and seizures (16). Eschar is the most pathognomonic of scrub typhus. It is a primary papule where the chigger has fed. It can occur anywhere in the body. Hidden areas like axilla, inguinal areas should be necessarily examined. In the present case series, there was eschar noted over the ear and the back. In Gao J et al., eschar was noted over the left groin in a 10-day-old neonate (13).

Similar to the present case series, Ghosh S et al., also had infants with multiorgan dysfunction. An 88% of the neonates in that study, required Paediatric intensive care unit admissions. Some neonates had respiratory distress and required ventilator support (17). In the present case series, three neonates required NICU stay. One baby with cardiac arrest required ventilation and subsequently succumbed to the illness. If scrub typhus is not treated by the second week systemic manifestations of the disease may start to develop (18). All systems can be affected. The CNS manifestations include meningitis, encephalopathy, acute diffuse encephalomyelitis, hearing loss, other ocular manifestations and cranial nerve palsies. Multiorgan dysfunction can develop which leads to death. Congestive cardiac failure, pericardial effusion, hypotensive shock and non specific rhythm abnormalities can be the cardiovascular manifestations. Respiratory system manifestations include interstitial pneumonia and acute respiratory distress. Two neonates in the present case series had thrombocytopenia similar to the study by Jang WS et al., (19). Diarrhoea, hepatosplenomegaly are common gastrointestinal manifestations of the disease. Pancreatitis and paralytic ileus are rare manifestations (20). In the present case series, two neonates presented with hypotensive shock and one with seizures. Scrub typhus is a close differential diagnosis for fever with thrombocytopenia. If appropriate treatment is unavailable scrub typhus can be a life threatening disease. The underlying risk factors for the severity of the disease are unclear. Babies presenting with shock at presentation are at increased risk for mortality (21). In the present case series, one baby who succumbed to illness presented with shock at admission. Timely intervention with doxycycline will prevent progression of the disease to severe complications like multiorgan dysfunction and Haemophagocytic Lymphohistiocytosis (HLH) (22). The current treatment option available to treat scrub typhus includes doxycycline, azithromycin, chloramphenicol, rifampicin and tetracycline. The choice of drug varies with different ages and regions. The commonly preferred drugs are doxycycline and azithromycin because of minimal side effects and better therapeutic index. Azithromycin is preferred over doxycycline in children under age of eight years and also as a parenteral drug in cases with haemodynamic instability in severe scrub typhus (23). In the present case series, authors treated three neonates with doxycycline and two neonates with azithromycin. The authors did not observe any side effects due to the medications.

Conclusion

Scrub typhus presents with nonspecific clinical features in neonates and it is underdiagnosed. Scrub typhus is a febrile illness which might have varied severe presentations like aseptic meningitis, paralytic ileus and septic shock. In endemic regions like Chennai, scrub typhus closely mimics dengue fever due to similar features of third spacing and thrombocytopenia. Hence, a high index of suspicion is required to diagnose it. Timely intervention will prevent mortality in severe scrub typhus.

Authors contributions: KV conceptualised the study; AP and KV compiled the clinical data: PL and REK drafted the manuscript. All authors provided critical inputs into revision of the article and are willing to be accountable for all aspects of the study.

References

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DOI and Others

DOI: 10.7860/JCDR/2023/62648.18048

Date of Submission: Jan 04, 2023
Date of Peer Review: Feb 23, 2023
Date of Acceptance: Apr 21, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 05, 2023
• Manual Googling: Mar 03, 2023
• iThenticate Software: Apr 08, 2023 (9%)

ETYMOLOGY: Author Origin

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