2-year-old with rickettsial disease & Covid survives

June 17, 2021

Arpit, a two-year-old boy from Nelamangala, had continuous seizures and a swollen body when he was brought to the emergency ward of a private hospital in Bengaluru recently.

His platelet count had dropped to 20,000, but the challenge was to control the seizures. At first, he didn’t respond to medicines on May 12, when he was brought to Columbia Asia referral hospital, Yeshwantpur, a unit of Manipal Hospitals and he was put on ventilator support.

Doctors realised that along with Covid, the child had also developed meningitis from a rickettsial infection. A rare tick-borne infection, rickettsial is a tropical disease and largely restricted to Malnad areas. But doctors say there have been cases in Bengaluru too. Arpit survived and was discharged on May 26, after prolonged treatment.

Although he developed high fever and rashes all over his body, his family didn’t take him to hospital for five days due to fear of Covid. They thought it was a case of ‘amma’, a colloquial term for chicken pox.

“Rickettsial fever is caused by tick bites and is especially seen in tropical places like ours in the monsoon season,” said Dr Supraja Chandrashekar, paediatric intensivist, who treated the boy. “The condition can be quite fulminant when not treated early and can cause complications like brain fever, low blood platelets, low blood pressure and in some cases even death.”

She said both Covid-19 and rickettsial infection together is extremely rare and not seen in the west. “Complications arising from either disease had to be considered along with post Covid multi-organ inflammatory syndrome (MIS) while treating the child,” she said.

Dr Gurudutt AV, paediatric intensivist at the hospital, who also treated the boy said that the crucial determining factor of a good outcome is to monitor if the child’s brain recovers without long-term effects despite two hours of continuous fits, brain fever that was unrecognised and a dual infection. “It was heartening to see the child wave bye and smile while going home after two weeks of stay. Every effort was worth it,” he said.

The boy’s case of dual infection was a case study recently presented in a meeting of the Indian Academy of Paediatrics, Bengaluru chapter.

During the Covid peak in early May, Arpit’s parents had to run from pillar to post to find a bed for the boy, but they eventually did. “Doctors began treatment immediately and the entire team were at his bedside for hours together till the child’s condition stabilised,” the boy’s mother said.