Scrub typhus and Spotted fever high prevalence in Kolar belt region. Question of emerging tetracycline

Two interesting cases , diagnosed as

1. TICK BORNE SPOTTED FEVER : 12 year old male child came to emergency dept with fever since 2 weeks, with cold peripheries, thready pulse with difficulty in breathing ,with hypotension and shock. Child was drowsy, had edema of limbs, puffiness of face , abdominal distension with hepatosplenomegaly. Immediately O2 was started, given Bolus of NS. Shifted to PICU for further management. Shock was treated aggressively with fluid resuscitation. Child was investigated which showed severe thrombocytopenia( 10k platelets) , was transfused with 4 units platelets. Blood reports showed positive weils felix test OX2 . Dengue serology was negative. Child was given tetracycline three doses outside but child did not respond. Hence was started with antibiotic AZITHRAL , responded well to it. Inj Xone , IVF , IV antacids and other supportive care was given. Dramatic response was seen in 48 hours Once platelets were more than 50k child was shifted to ward. After 5 days of Azithromycin ,child was hemodynamically stable taking oral feeds, with platelets of >1.5 lakhs hence was discharged successfully.

2. SCRUB TYPHUS : 9 year old female child with complaints of fever since 10 days, pain abdomen, vomitings, congestion of eyes . Hemodynamically stable, had hepatosplenomegaly. Was treated with antibiotics including 3 doses of oral tetracycline outside , no response was seen. Child was investigated , had severe thrombocytopenia (platelets 7k) , given platelet transfusion, later diagnosed with OX-K positive in weil felix test ( scrub typhus). Again dramatic response was seen with AZITHROMYCIN, in 24 hours child was symptomatically better, discharged after 5 days course with platelet counts of 3.5lakhs.

NOTE :

Rickettsial diseases a re- emerging infections, are under-diagnosed / overdiagnosed.. As the disease poses a challenge to diagnosis in its early clinical course, late presentations is very common with complications such as ARDS, meningoencephalitis and organ failures which have a higher risk of mortality (30%) are increasingly being reported from many parts of India.

Like all antibiotics, tetracycline is susceptible to bugs that develop resistance. There is evidence this has already occurred in settings where the drug is widely used, such as treatment of acne and casual use of drug for all fever cases. This means its use may be curtailed or overtaken by alternative drugs for some conditions, now or in the future.

” BEWARE BEFORE ITS TOO LATE “

Regards

Department of Paediatrics

Vamshodaya hospital