Paediatric Scrub Typhus Complicated by Myocarditis and Acute Respiratory Distress Syndrome: A Series of Four Cases

Scrub typhus is an emerging zoonotic infection in Southeast Asia that can cause severe complications in children, including myocarditis and Acute Respiratory Distress Syndrome (ARDS). A case series of paediatric patients presenting with fever, respiratory distress, and cardiovascular compromise requiring intensive care is described here. In all the cases, laboratory evaluation revealed thrombocytopenia, elevated inflammatory markers, and positive Orientia tsutsugamushi IgM ELISA. Echocardiography confirmed myocarditis with reduced Left Ventricular Ejection Fraction (LVEF), while ARDS was diagnosed on clinical and radiographic grounds. Cases were managed with doxycycline, Intravenous Immunoglobulin (IVIG), ionotropic support, and ventilatory measures. While three patients improved with timely intervention, one child succumbed to illness, which reflects the potential severity of scrub typhus in paediatric age groups. This series emphasises the importance of early recognition and prompt management in endemic regions to prevent life-threatening complications and reduce morbidity and mortality. Clinicians in endemic regions should maintain a high index of suspicion for scrub typhus in children presenting with acute febrile illness and cardiorespiratory compromise, as early diagnosis and targeted therapy can be lifesaving.