Objectives We planned this study to determine the clinical spectrum and compare incidence of multiorgan dysfunction in children hospitalized with scrub typhus with other etiologies of tropical fever. Design Prospective cohort study. Setting Pediatric emergency and PICU services of a university teaching hospital situated in the sub-Himalayan region. Patient Children aged 2 months to 14 years with acute undifferentiated fever of more than 5 days. Interventions Detailed fever workup was performed in all children. We compared scrub typhus IgM positive children (cases) with remaining febrile children who were negative for scrub IgM assay (controls) for mortality and morbidity. Main results We enrolled 224 febrile children; 76 children (34%) were positive for scrub typhus IgM ELISA. Scrub typhus group had a significantly higher incidence of multiorgan dysfunction [OR 3.5 (95% CI 2.0–6.3); p < 0.001] as compared to non-scrub typhus group requiring supportive care. The incidence of altered sensorium [OR 8.8 (95% CI 3.1–24.9)], seizures [OR 3.0 (95% CI 1.1–8.3)], acute respiratory distress syndrome [OR 17.1 (95% CI 2.1–140.1)], acute renal failure (5% vs. 0%), meningitis [OR 6.2 (95% CI 1.2–31.6)], thrombocytopenia [OR 2.8 (95% CI 1.5–5.1)], transaminitis [OR 2.7 (95% CI 1.6–4.8)], requirement of oxygen [OR 17.8 (95% CI 4.0–80.3)], positive pressure support [OR 3.7 (95% CI 1.2–10.5)] and shock requiring inotropes [OR 3.0 (95% CI 1.3–6.7)] was significantly higher in scrub typhus group as compared to the non-scrub typhus group (Table 1). Conclusions Pediatric scrub typhus who were hospitalized had severe systemic manifestations when compared to other causes of fever.

中文翻译：

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恙虫病感染多器官功能障碍谱

目的 我们计划进行这项研究以确定临床谱，并比较因恙虫病住院的儿童与其他热带热病因的多器官功能障碍的发生率。设计前瞻性队列研究。为位于亚喜马拉雅地区的大学教学医院设置儿科急诊和 PICU 服务。患者 2 个月至 14 岁的儿童急性未分化热超过 5 天。干预 对所有儿童进行了详细的发热检查。我们比较了恙虫病 IgM 阳性儿童（病例）与其余发热儿童（对照组）恙虫病 IgM 检测阴性的死亡率和发病率。主要结果 我们招募了 224 名发热儿童；76 名儿童 (34%) 的恙虫病 IgM ELISA 呈阳性。恙虫病组多器官功能障碍的发生率显着升高 [OR 3.5 (95% CI 2.0–6.3)；p＜0.001] 与需要支持治疗的非擦洗斑疹伤寒组相比。感觉器官改变 [OR 8.8 (95% CI 3.1–24.9)]、癫痫发作 [OR 3.0 (95% CI 1.1–8.3)]、急性呼吸窘迫综合征 [OR 17.1 (95% CI 2.1–140.1)]、急性肾功能衰竭（5% 对 0%）、脑膜炎 [OR 6.2 (95% CI 1.2–31.6)]、血小板减少症 [OR 2.8 (95% CI 1.5–5.1)]、转氨酶 [OR 2.7 (95% CI 1.6–4.8) )]、氧气需求 [OR 17.8 (95% CI 4.0–80.3)]、正压支持 [OR 3.7 (95% CI 1.2–10.5)] 和需要正性肌力药的休克 [OR 3.0 (95% CI 1.3–6.7)]与非恙虫病组相比，恙虫病组明显高于非恙虫病组（表 1）。