Clinical Profile and Outcome of Scrub Typhus Myocarditis in Children: A Retrospective Observational Study

Background and Objective: Scrub typhus is an important cause of acute febrile illness in children living in tropical regions and is associated with several systemic complications. Myocarditis is a serious cardiovascular manifestation that may result in cardiac failure, cardiogenic shock, and mortality if not recognized early. Our objective was to study the clinical profile, management, and outcomes of children diagnosed with scrub typhus myocarditis. Materials and Methods: This retrospective observational study was conducted in the Pediatrics Department of a tertiary care teaching hospital in Bhubaneswar from 2018 to 2022. Children aged 1 month–14 years diagnosed with scrub typhus by positive immunoglobulin M serology and fulfilling criteria for myocarditis were included. Myocarditis was diagnosed based on acute-onset heart failure, hemodynamic compromise, reduced ejection fraction, elevated cardiac enzyme levels, and electrocardiographic abnormalities. Demographic details, clinical features, laboratory investigations, radiological findings, treatment details, and outcomes were analyzed using Statistical Package for the Social Sciences version 24.0. Results: Among 180 children with scrub typhus, 39 (21.7%) were diagnosed with myocarditis. The mean age was 6.1 years, with male predominance (2.8:1). Fever was present in all cases, followed by swelling of body parts (86.8%), hepatomegaly (89.4%), tachycardia (89.4%), cough (71%), tachypnea (65.7%), and hypotension (36.8%). Elevated creatine phosphokinase-myocardial band levels were observed in 42.5% of children, while abnormal electrocardiographic findings were present in 26.3% of children. Most patients had mild left ventricular dysfunction. Oxygen therapy was required in 63.1% of cases, ionotropic support in 31.5%, noninvasive ventilation in 21.1%, and invasive ventilation in 13.1%. Mortality was 2.6%. Conclusion: Myocarditis is a common and potentially life-threatening complication of scrub typhus in children. Early recognition, prompt supportive management, and careful cardiac monitoring can significantly improve the outcomes and reduce mortality.