A Study on Clinical Profile and Complications of Acute Rickettsial Diseases in Children at A Tertiary Care Hospital of Western Maharashtra

Background: Rickettsial infections are progressively becoming a major cause of acute febrile illness in the paediatric age group, especially in a few endemic regions of India. The multi-organ involvement in these infections is often common and can get complicated if diagnosis and treatment are not done promptly. The objective is to compose the clinical presentation and complications of the rickettsial infection in hospitalized children in a tertiary care hospital in Westerly, Maharashtra. Material and Methods: We conducted a retrospective study of serologically confirmed rickettsial infections in children aged 1 month to 18 years. Demographic data, clinical manifestations, laboratory parameters, and complications were retrieved from the medical records database through search and analysis. Results: 61 children were included per the inclusion criteria, with a slight male bias (54.1%). A larger part of them (37.7%) were below 5 years old. Fever persisted in all these cases, with prolonged fever (>5 days) observed in 60.7% of children. Escher was detected in 59% of the children; common manifestations were gastrointestinal (vomiting: 54.1% and hepatosplenomegaly: 50.8%), dermatological (rash: 39.3%), and neurological (altered sensorium: 27.9% and convulsions: 13.1%). When laboratory parameters were evaluated, anemia was 88.5%, thrombocytopenia 77%, leukocytosis 72.1%, and hypoalbuminemia 75.4%. The prevalent complications reported were meningoencephalitis (29.5%), shock (26.2%), acute hepatitis (24.6%), acute kidney injury (19.7%), pneumonia (16.4%), myocarditis (11.5%), and ARDS (8.2%). Conclusion: Pediatric rickettsial infections can present through a wide range of clinical presentations, and often, multi-organ involvement is likely to exist. Early detection of key clinical manifestations and laboratory abnormalities can serve as a predictive marker for early diagnosis and timely treatment, helping achieve better outcomes. The study validates the pertinence of recognizing pediatric rickettsial disease as an endemic and the necessity of combining early diagnosis and risk-stratification approaches in the practice of modern pediatrics. Keywords: Acute Rickettsial Diseases, Pediatric Rickettsial Infections, Clinical Profile, Complications, Children, Tertiary Care Hospital, Western Maharashtra, Scrub Typhus, Febrile Illness, Pediatric Infectious Diseases.