Neonatal Scrub Typhus: A Case Series

Excerpt

To the Editor: Scrub typhus, a rickettsial infection caused by Orientia tsutsugamushi is endemic in south India [1]. However, presentation in neonates is rare. We describe the clinical profile of 7 neonates admitted to a tertiary care NICU between January 2022 and March 2023 with fever, later diagnosed to have scrub typhus based on a positive RT-PCR (56 kDa gene). The mean gestational age was 38.1 (1.6) wk, and birthweight 3000 (629) g. Median age at symptom onset was 21 d (range: 2–30). All seven cases had fever and thrombocytopenia, while 85% (6/7) had hepatosplenomegaly. Seventy-one percent (5/7) had transaminitis, 57% (4/9) required respiratory support, 43% (3/7) had multi-organ dysfunction, 29% (2/7) had shock, and one had disseminated intravascular coagulation (DIC). One of them also had evidence of transplacentally acquired infection, the neonate being symptomatic at 36 h of life with positive scrub typhus PCR in both mother and baby. The same neonate also had meningitis and received treatment for 10 d. All neonates were initially started on empirical antibiotics for neonatal sepsis, which were changed to doxycycline after suspicion/confirmation of scrub typhus. One neonate received azithromycin in addition to doxycycline due to poor response. One neonate who had Multiple organ dysfunction syndrome (MODS) at admission succumbed despite initiation of doxycycline. The other six responded to treatment and were discharged. Response to treatment was heralded by defervescence of fever, regression of organomegaly, and improvement in vital parameters in all cases except the one who eventually succumbed. Twenty-two cases of neonatal scrub typhus have been reported so far in literature, with a mortality rate of 18% [2, 3]. Eschar has been reported in 18% of published cases, but no neonate in our series had eschar. Fever, hepatosplenomegaly and thrombocytopenia in a neonate should arouse suspicion of scrub typhus in endemic areas. Early initiation of doxycycline improves outcomes [4]. …