Department of Pediatrics, Choithram Hospital and Research Centre,  Indore, Madhya Pradesh, India.
Email: [email protected] 

We read with interest the article on Rickettsial diseases by Rathi, et al. [1]. The author mentions that no case of Ricketssia has been reported from Madhya Pradesh. We herein report a child with features suggestive of rickettsial infection, whom we recently managed.

A 1-year 6 month old child from Shajapur, MP, presented to us with a history of fever for 20 days. On day 3, she had developed a generalized rash starting from the trunk which spread to the palms and soles over the next few days. On day 5, she developed congestion of conjunctiva and of the oral cavity and on day 7 she had left focal seizures. She was admitted at a local hospital where her investigations revealed a Hb of 7.0 g/dL, a normal leukocyte count, and platelet count of 80,000/cc. Her CSF examination was not done. She received antibiotics and anti convulsants for a week. However since her fever did not resolve she was referred to us. On examination she was irritable, had a generalized maculopapular, petechial rash all over the body, including palms and soles. She had edema over the dorsum of hands and feet but no organomegaly, lymphadenopathy or meningeal signs. Her total leukocyte count was 29,800 per cu mm with polymorphs of 84%, platelet count was 4.5 lakhs, ESR was 60, and CRP was elevated. Weil Felix test was positive in a titre of 1: 160 for Proteus Ag Ox 19 and 1: 80 for Proteus Ag Ox K. She was started on oral doxycycline. She became afebrile in 48 hours.

We used the clinical scoring system described by Rathi, et al. [1] and she had a score of 17 which is considered to have a specificity of 100%. We could not do the Elisa for IgM antibodies to Rickettsia because of financial constraints.