Clinical profile and predictors of severity in infantile scrub typhus: A prospective observational study from a tertiary care teaching hospital in Southern India Dinesh Kumar Narayanasamy, Thirunavukkarasu Arun Babu, Prakash Mathiyalagen Journal of Vector Borne Diseases, 2026 Background & objectives: Scrub typhus (ST), a tropical infection caused by Orientia tsutsugamushi , has re-emerged as a global concern in the Asia-Pacific region. Limited data on ST in infants reveals unique presentations, complications, and severity predictors. This study was conducted to evaluate the occurrence of ST in infants, comparing clinical, laboratory and outcomes with ST in older children. Methods: This is a prospective cohort study conducted in the Pediatrics Department of a teaching hospital in South India. Children <12 years of age presenting with fever for >5 days with serology confirmed ST using IgM ELISA for ST were included after excluding other common tropical infections. Results: Out of 650 children, 60 (10%) were infants. Fever (100%) was the most common presentation with mean duration of 9 days followed by cough and fast breathing. Eschar (33, 55%) was commonly seen in the face (14, 23.3%) and were atypical (10, 16.6%) in appearance. Findings such as pallor, oedema, hepatosplenomegaly, lung crackles and hematological abnormalities like anemia, leukocytosis, elevated transaminases were more prevalent in infants compared to older children. Severe ST was observed in 34 (56.7%) infants, commonly presenting with pneumonia and shock. Doxycycline showed quicker defervesence with no adverse events in infants. Logistic regression identified hypoalbuminemia as a significant predictor of severe ST in infants. Interpretation & conclusion: ST in infants is common and poses a diagnostic challenge due to overlapping features with other tropical infections. Timely therapy and risk stratification can improve outcomes in resource limited settings.
Prospective study to assess the response to therapy and its predictors in children with scrub typhus Thirunavukkarasu Arun Babu, Dinesh Kumar Narayanasamy, Limalemla Jamir Journal of Tropical Pediatrics, 2021 Doxycycline is the drug of choice for pediatric scrub typhus (ST) while azithromycin is considered as an equally effective alternative. This study was undertaken to assess the response to therapy and its predictors in pediatric ST cases treated with doxycycline and azithromycin. Children ≤12 year with fever ≥7 days were screened for ST by IgM ELISA (positive if optical density &gt;0.5). All positive cases were divided into two groups based on whether treated with doxycycline or azithromycin. Fever clearance time (FCT), duration of hospitalization and other clinical characteristics of cases in both groups were compared. Out of 2710 children admitted with fever for more than 7 days, 660 cases (24.35%) tested positive for ST by IgM ELISA. Cases treated with azithromycin and doxycycline were 316 (47.87%) and 344 (52.12%), respectively. In our study, the FCT (p = 0.004), mean duration of hospital stay (p = 0.011), persistence of fever for &gt;48 h after starting antibiotic therapy (p = 0.001) and severe ST requiring ICU admission (p = 0.046) were significantly lower in children who received doxycycline. The logistic regression analysis revealed that the presence of splenomegaly (Adjusted Odds Ratio (AOR) 2.60; 95% Confidence interval (CI) = 1.49–4.53; p = 0.001) and lung crepts (AOR 2.02; 95% CI = 1.06–3.85; p = 0.032) in azithromycin-treated group and presence of meningeal signs (AOR 16.11; 95% CI = 5.47–47.45; p &lt; 0.001), anemia (AOR 2.28; 95% CI = 1.02–5.08; p = 0.044), lung crepts (AOR 2.66; 95% CI = 1.16–6.05; p = 0.020) and absence of eschar (AOR 3.48; 95% CI = 1.70–7.13; p = 0.001) in the doxycycline group was significantly associated with prolonged FCT (&gt;48 h). Doxycycline is superior to azithromycin in defervescing fever, reducing hospital stay and preventing severity in pediatric ST.
Clinical profile and predictors of severity in paediatric scrub typhus with pulmonary involvement Dinesh Kumar Narayanasamy, Thirunavukkarasu Arun Babu, Prakash Mathiyalagen Tropical Doctor, 2021 Pulmonary involvement is common in children with scrub typhus. Our paper outlines the clinical characteristics of pulmonary involvement and analyses the predictors of its severity. All scrub typhus serology-positive (optical density >0.5) children with pulmonary symptoms were included. Of 506 serology-positive scrub typhus cases, 256 (50.5%) had pulmonary symptoms, of whom 50 (9.8%) were severe. These severe cases were compared with non-severe cases. Interstitial pneumonitis was the commonest chest radiographic finding. Logistic regression analysis identified ‘fever clearance time’ >48 h, facial puffiness, maculopapular rash and anaemia to be significantly associated with severe pulmonary involvement.
Radiographic Clues to Mercury Ingestion in a Neonate DK Narayanasamy, D DeepakRaj, D Jegannayagalu, T Vasanthan Indian Journal of Pediatrics, 1-2 , 2026 2026
Eyelid Swelling Revealing Scrub Typhus: Diagnostic Value of Eschar PCR DK Narayanasamy, V Tanigasalam, D Jeganayagalu, R Dhodapkar, ... Indian Journal of Pediatrics 93 (4), 434-434 , 2026 2026
Haematologic profile and predictors of outcome in paediatric scrub typhus: A prospective observational study DK Narayanasamy, A Shankaralingappa, TA Babu Karnataka Paediatric Journal , 2026 2026
Clinical Profile and Predictors of Severity in Infantile Scrub Typhus – A Prospective observational study from a Tertiary Care Teaching Hospital in Southern India DK Narayanasamy, TA Babu, P Mathiyalagen Journal of Vector Borne Diseases , 2025 2025 Citations: 1
Clinical profile and outcomes of pediatric scrub typhus associated with elevated hepatic transaminases DK Narayanasamy, T Arun Babu, J Fredrick, D Kittu Indian Journal of Gastroenterology 42 (3), 347-354 , 2023 2023 Citations: 7
Neonatal Scrub Typhus with an Eyelid Eschar Masquerading as “Late-onset Sepsis” DK Narayanasamy, TA Babu Indian Pediatrics Case Reports 2 (4), 249-251 , 2022 2022 Citations: 1
Prospective study to assess the response to therapy and its predictors in children with scrub typhus T Arun Babu, DK Narayanasamy, L Jamir Journal of Tropical Pediatrics 67 (5), fmab087 , 2021 2021 Citations: 12
Clinical profile and predictors of severity in paediatric scrub typhus with pulmonary involvement DK Narayanasamy, TA Babu, P Mathiyalagen Tropical Doctor 51 (3), 382-386 , 2021 2021 Citations: 7
Acute febrile infant with stridor: Rare presentation of pediatric scrub typhus. D Narayanasamy, T Babu Indian Journal of Respiratory Care 10 (2), 268-268 , 2021 2021
“Mite bite” sign: a novel atypical eschar of pediatric scrub typhus TA Babu, DK Narayanasamy Indian Journal of Paediatric Dermatology 22 (2), 174-176 , 2021 2021 Citations: 2
Stye can lie!–A rare presentation of scrub typhus eschar DK Narayanasamy, T Arun Babu Indian Journal of Pediatrics 88 (4), 417-417 , 2021 2021 Citations: 4
The Need for Geographic Location Specific Optical Density Cut-offs for IgM ELISA Serology to Diagnose Scrub Typhus in Children TA Babu, DK Narayanasamy Indian Pediatrics 58 (1), 95 , 2021 2021 Citations: 1
Comparative Efficacy of Doxycycline vs . Azithromycin in Pediatric Scrub Typhus T Arun Babu, DK Narayanasamy, P Mathiyalagen The Indian Journal of Pediatrics 88 (1), 93-93 , 2021 2021 Citations: 10
Crusty umbilical ulcer in a febrile child DKN Thirunavukkarasu Arun Babu Pediatric Dermatology , 2020 2020
Drug therapy in Pediatric Scrub Typhus–Is ‘not Giving Azithromycin’a Risk Factor for PICU Admission? TA Babu, DK Narayanasamy Nepal Health Research Council , 2020 2020 Citations: 3
Cardiovascular System DK Narayanasamy Pediatrics for medical graduates, Elsevier India 1 , 2019 2019
Clinical profile of scrub typhus meningoencephalitis among South Indian children N Dinesh Kumar, T Arun Babu, V Vijayadevagaran, S Ananthakrishnan, ... Journal of Tropical Pediatrics 64 (6), 472-478 , 2018 2018 Citations: 19
Predictors of severity in pediatric scrub typhus DK Narayanasamy, T Arun Babu, V Vijayadevagaran, D Kittu, ... The Indian Journal of Pediatrics 85 (8), 613-617 , 2018 2018 Citations: 26
Clinico-laboratory profile of scrub typhus—an emerging rickettsiosis in India DK Narayanasamy, AK Arunagirinathan, RK Kumar, VD Raghavendran The Indian Journal of Pediatrics 83 (12), 1392-1397 , 2016 2016 Citations: 56
Congenital nasal pyriform aperture stenosis: A rare cause of respiratory distress in newborn ND Kumar, AA Kumaran, S Balaji, R Anupriya Journal of Clinical Neonatology 4 (3), 203-205 , 2015 2015 Citations: 3
MOST CITED SCHOLAR PUBLICATIONS
Clinico-laboratory profile of scrub typhus—an emerging rickettsiosis in India DK Narayanasamy, AK Arunagirinathan, RK Kumar, VD Raghavendran The Indian Journal of Pediatrics 83 (12), 1392-1397 , 2016 2016 Citations: 56
Predictors of severity in pediatric scrub typhus DK Narayanasamy, T Arun Babu, V Vijayadevagaran, D Kittu, ... The Indian Journal of Pediatrics 85 (8), 613-617 , 2018 2018 Citations: 26
Clinical profile of scrub typhus meningoencephalitis among South Indian children N Dinesh Kumar, T Arun Babu, V Vijayadevagaran, S Ananthakrishnan, ... Journal of Tropical Pediatrics 64 (6), 472-478 , 2018 2018 Citations: 19
Incontinentia pigmenti: a rare genodermatosis in a male child DKN Swamy, A Arunagirinathan, R Krishnakumar, S Sangili Journal of Clinical and Diagnostic Research: JCDR 9 (2), SD06 , 2015 2015 Citations: 13
Prospective study to assess the response to therapy and its predictors in children with scrub typhus T Arun Babu, DK Narayanasamy, L Jamir Journal of Tropical Pediatrics 67 (5), fmab087 , 2021 2021 Citations: 12
Comparative Efficacy of Doxycycline vs . Azithromycin in Pediatric Scrub Typhus T Arun Babu, DK Narayanasamy, P Mathiyalagen The Indian Journal of Pediatrics 88 (1), 93-93 , 2021 2021 Citations: 10
Clinical profile and outcomes of pediatric scrub typhus associated with elevated hepatic transaminases DK Narayanasamy, T Arun Babu, J Fredrick, D Kittu Indian Journal of Gastroenterology 42 (3), 347-354 , 2023 2023 Citations: 7
Clinical profile and predictors of severity in paediatric scrub typhus with pulmonary involvement DK Narayanasamy, TA Babu, P Mathiyalagen Tropical Doctor 51 (3), 382-386 , 2021 2021 Citations: 7
Stye can lie!–A rare presentation of scrub typhus eschar DK Narayanasamy, T Arun Babu Indian Journal of Pediatrics 88 (4), 417-417 , 2021 2021 Citations: 4
Drug therapy in Pediatric Scrub Typhus–Is ‘not Giving Azithromycin’a Risk Factor for PICU Admission? TA Babu, DK Narayanasamy Nepal Health Research Council , 2020 2020 Citations: 3
Congenital nasal pyriform aperture stenosis: A rare cause of respiratory distress in newborn ND Kumar, AA Kumaran, S Balaji, R Anupriya Journal of Clinical Neonatology 4 (3), 203-205 , 2015 2015 Citations: 3
“Mite bite” sign: a novel atypical eschar of pediatric scrub typhus TA Babu, DK Narayanasamy Indian Journal of Paediatric Dermatology 22 (2), 174-176 , 2021 2021 Citations: 2
Clinical Profile and Predictors of Severity in Infantile Scrub Typhus – A Prospective observational study from a Tertiary Care Teaching Hospital in Southern India DK Narayanasamy, TA Babu, P Mathiyalagen Journal of Vector Borne Diseases , 2025 2025 Citations: 1
Neonatal Scrub Typhus with an Eyelid Eschar Masquerading as “Late-onset Sepsis” DK Narayanasamy, TA Babu Indian Pediatrics Case Reports 2 (4), 249-251 , 2022 2022 Citations: 1
The Need for Geographic Location Specific Optical Density Cut-offs for IgM ELISA Serology to Diagnose Scrub Typhus in Children TA Babu, DK Narayanasamy Indian Pediatrics 58 (1), 95 , 2021 2021 Citations: 1
Radiographic Clues to Mercury Ingestion in a Neonate DK Narayanasamy, D DeepakRaj, D Jegannayagalu, T Vasanthan Indian Journal of Pediatrics, 1-2 , 2026 2026
Eyelid Swelling Revealing Scrub Typhus: Diagnostic Value of Eschar PCR DK Narayanasamy, V Tanigasalam, D Jeganayagalu, R Dhodapkar, ... Indian Journal of Pediatrics 93 (4), 434-434 , 2026 2026
Haematologic profile and predictors of outcome in paediatric scrub typhus: A prospective observational study DK Narayanasamy, A Shankaralingappa, TA Babu Karnataka Paediatric Journal , 2026 2026
Acute febrile infant with stridor: Rare presentation of pediatric scrub typhus. D Narayanasamy, T Babu Indian Journal of Respiratory Care 10 (2), 268-268 , 2021 2021
Crusty umbilical ulcer in a febrile child DKN Thirunavukkarasu Arun Babu Pediatric Dermatology , 2020 2020
