Neonatal Scrub TyphusA Series of Five Cases

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 (2 females and 3 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.