Clinical features and risk factors for severe pediatric scrub typhus in Liangshan Prefecture, China: A retrospective cohort study

This study aimed to analyze the clinical characteristics and identify risk factors for severe disease in pediatric scrub typhus in Liangshan Prefecture, a resource-limited region, to facilitate early diagnosis and intervention, thereby improving outcomes and reducing mortality. We conducted a retrospective study of 103 children with confirmed scrub typhus admitted to a major hospital in Liangshan between July 2023 and December 2024. Patients were classified into severe and non-severe groups. Demographics, clinical features, and laboratory parameters were compared. Univariate logistic regression was performed to identify laboratory parameters associated with disease severity. Due to the limited number of severe cases ( n = 12), multivariable analysis was not performed. A total of 103 children were enrolled, comprising 92 mild and 11 severe cases. The majority of children (53.4%) were aged 5–11 years. A distinct seasonal peak was observed from August to September (84.5%). Universal clinical manifestations included fever (100%) and eschar/ulcer (100%). Compared to the mild group, severe cases demonstrated significantly higher levels of CRP, AST, and LDH, and more pronounced reductions in hemoglobin (Hb), platelet count(PLT), fibrinogen, and albumin (all P < 0.05). Univariate analysis using categorized laboratory parameters identified decreased albumin (OR: 20.54, 95% CI: 4.07–376.76, P < 0.001), decreased hemoglobin (OR: 4.53, 95% CI: 1.38–15.87, P = 0.011), and decreased platelet count (OR: 3.20, 95% CI: 1.03–12.22, P = 0.037) as significant risk factors for severe disease. In resource-limited settings during scrub typhus season, the constellation of fever, eschar/ulcer, hepatomegaly, lymphadenopathy, and characteristic laboratory derangements supports the diagnosis. Among these, elevated CRP and LDH, coupled with reductions in PLT, fibrinogen, Hb, and particularly albumin, should alert clinicians to severe disease, enabling early intervention and improved prognosis.