We read with interest the article on Rickettsial diseases by Rathi,
et al. [1]. The author mentions that no case of Ricketssia has been
reported from Madhya Pradesh. We herein report a child with features
suggestive of rickettsial infection, whom we recently managed.
A 1-year 6 month old child from Shajapur, MP,
presented to us with a history of fever for 20 days. On day 3, she had
developed a generalized rash starting from the trunk which spread to the
palms and soles over the next few days. On day 5, she developed
congestion of conjunctiva and of the oral cavity and on day 7 she had
left focal seizures. She was admitted at a local hospital where her
investigations revealed a Hb of 7.0 g/dL, a normal leukocyte count, and
platelet count of 80,000/cc. Her CSF examination was not done. She
received antibiotics and anti convulsants for a week. However since her
fever did not resolve she was referred to us. On examination she was
irritable, had a generalized maculopapular, petechial rash all over the
body, including palms and soles. She had edema over the dorsum of hands
and feet but no organomegaly, lymphadenopathy or meningeal signs. Her
total leukocyte count was 29,800 per cu mm with polymorphs of 84%,
platelet count was 4.5 lakhs, ESR was 60, and CRP was elevated. Weil
Felix test was positive in a titre of 1: 160 for Proteus Ag Ox 19 and 1:
80 for Proteus Ag Ox K. She was started on oral doxycycline. She became
afebrile in 48 hours.
We used the clinical scoring system described by
Rathi, et al. [1] and she had a score of 17 which is considered
to have a specificity of 100%. We could not do the Elisa for IgM
antibodies to Rickettsia because of financial constraints.
Reference
1. Rathi NB, Rathi AN, Goodman MH, Aghai ZH.
Rickettsial Diseases in Central India: Proposed clinical scoring system
for early detection of spotted fever. Indian Pediatr. 2011;48:867-72.