Rickettsial Infections in Febrile Paediatric Patients: Observations from a Tertiary Care Hospital in Cumilla, Bangladesh
TL;DR
Rickettsial infections in children are underdiagnosed but potentially severe and recognition, High clinical suspicion, early recognition and prompt appropriate therapy are essential to reduce morbidity and mortality.
Abstract
Background: Rickettsial infections are emerging tropical diseases caused by obligate intracellular, pleomorphic gram-negative coccobacilli. Early diagnosis is difficult because serological tests vary greatly in sensitivity and specificity. Although the Indirect Immunofluorescence Antibody (IFA) test is the gold standard, its high cost and limited availability restrict its use. Therefore, the Weil-Felix test is still widely used in rural areas for presumptive diagnosis. Materials and Methods: This prospective cross-sectional study was conducted in the Paediatric Department of Eastern Medical College Hospital (EMCH), Cumilla, from January to December 2025, after obtaining ethical approval from the IERB of EMC, to evaluate the clinico-demographic patterns and frequency of suspected rickettsial infections among febrile children. A total of 110 children (≤12 years) were enrolled by convenient sampling. Children over 12 years, those with confirmed other causes of fever, lack of guardian consent, or critical ill cases were excluded. Data was collected using a pre-tested structured questionnaire containing sociodemographic details, history, and clinical findings. Laboratory tests, including CBC and the Weil-Felix test, were performed. Written informed consent was obtained from each child’s legal guardian. Collected data were analyzed in SPSS version 25. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize the findings. Results: In total, 110 children were enrolled, with a slight male predominance (53% vs. 47%). The mean duration of fever was 6.9 ± 1.3 days. Most children belonged to the 4-6 year age group (40;36.4%), followed by those aged 7-9 years (31;28.2%). The mean age of the study participants was 6.1±2.7 years. The overall percentage of rickettsial infection was 35.5%. Among the positive cases, OX-19 was the most frequent antigen (22; 20.0%), followed by OX-K (19; 17.3%) and OX-2 (18; 16.4%). The most frequently reported clinical features were altered bowel habits (26; 23.6%) and both headache and vomiting (21; 19.1% each). Abdominal pain was noted in 8 cases (7.3%), while rash was present in 7 cases (6.4%). Leukocytosis was observed in 12 cases (10.9%). Conclusion: Rickettsial infections in children are underdiagnosed but potentially severe. Early recognition, High clinical suspicion, early recognition and prompt appropriate therapy are essential to reduce morbidity and mortality. The Weil-Felix test can be useful for presumptive diagnosis in rural settings. Eastern Med Coll J. January 2026 Vol.11 No.1 : 9-13