Scrub typhus masquerading as other conditions among the pediatric population in India: a case series

India is an endemic country for scrub typhus, a common rickettsial infection caused by Orientia tsutsugamushi contracted through the bite of infected mites. Though relatively common in the pediatric population, early diagnosis sometimes becomes difficult due to its atypical presentation. We reported five febrile children who had varied presentations like convulsion, jaundice, generalized edema, or features like Kawasaki disease, and only one had pathognomonic eschar. They were diagnosed with acute disseminated encephalomyelitis, nephrotic syndrome, hepatitis, or Kawasaki phenotype hyperinflammatory syndrome along with positive scrub typhus IgM in all cases. They recovered with doxycycline and other disease-specific treatments like intravenous methylprednisolone, immunoglobulin, and oral prednisolone. All of them were discharged in stable condition. The variety and rarity of some presentations of pediatric scrub typhus should prompt pediatricians to have a high index of suspicion for scrub typhus in cases that present similarly to these cases.