Abstract:

Tsutsutsugamushi disease (TD) is a natural epidemic disease caused by orientia tsutsugamushi (Ot) infection, and all people are generally susceptible to Ot. Insufficient attention to children with TD in China leads to a high incidence of misdiagnosis and mistreatment. This article reviews the clinical features of children with TD, in order to improve the clinical understanding of children’s TD. The incidence of characteristic signs of TD eschar in children with TD was 34.6%-70.5%, and the incidence of rash was only 10%-20%, which was the main cause of the misdiagnosis and mistreatment. TD has a high incidence of nervous system infection, liver damage, thrombocytopenia, anemia and myocarditis in children. TD should be suspected in children with high fever and multiple system involvement. The mortality rate of TD in children was as high as 4.8%-12.2%. The causes of death are multiple organ failure, acute respiratory distress syndrome and hemophagocytic syndrome. TD should be differentiated from severe fever with thrombocytopenia syndrome (SFTS), dengue fever, typhoid fever, leptospirosis, epidemic hemorrhagic fever and kala-azar. Detection of Ot in blood and/or eschar by polymerase chain reaction (PCR), detection of Ot antibody IgM in blood by enzyme-linked immunosorbent assay (ELISA) was a mature technology for TD etiological diagnosis, and there were also reports using macro gene second-generation sequencing technology to diagnose TD. Ot was an intracellular parasite, and the application of antibiotics doxycycline, azithromycin, chloramphenicol and clarithromycin, which could enter the cell and could achieve remarkable curative effect.

Key words: Tsutsugamushi disease, Children, Clinical characteristics, Diagnosis, Differential diagnosis, Antimicrobial drugs