Liver dysfunction in children with scrub typhus: association with severity of illness and outcome

Background: Liver dysfunction is a common finding in children with scrub typhus. Adult literature has found a significant association between the extent of liver dysfunction and severity of illness and outcome. However, very few studies are available on children. Objectives: To study the extent of liver dysfunction in children with scrub typhus and its association with severity of illness and outcome. Method: It was a retrospective descriptive study conducted on children diagnosed with scrub typhus admitted to a tertiary care centre in south India from January 2016 to December 2020. Children from 1 month to 18 years of age were included. Demographic data, clinical details, laboratory parameters, course of illness and outcome data were collected and analysed. Results: Study population included 143 cases of scrub typhus. Mean age of the study population was 8.4 ± 4.4 years with a male: female ratio of 1.2:1. Fever was present in 100%, myalgia in 54.5%, decreased appetite in 54.5%, jaundice in 8.4% and hepatomegaly in 71.3% of children. Abnormal liver function tests were present in 75.5% children. Elevated aspartate transaminase (AST) was seen in 75.5%, elevated alanine transaminase (ALT) in 67.1%, hypoalbuminaemia in 47.5% and severe hypoalbuminaemia (<2.5g/dL) in 29.4%. Complications included meningitis (13.3%), shock (7.6%), meningoencephalitis (2.7%) and acute respiratory distress syndrome (2%). There were 2 (1.3%) deaths. Children with complications had higher AST (p <0.01), ALT (p = 0.018), low serum albumin (p<0.001) and prolonged international normalised ratio (INR) (p =0.003). Conclusions: Abnormal liver function tests were present in 75.5% of children with scrub typhus. Children with complications of scrub typhus had significantly higher median AST levels, ALT levels, low serum albumin levels and prolonged INR compared to children with no complications.