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CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India

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Abstract

Objective

To present the clinical, lab profile and outcome of a series of six children who had features of meningoencephalitis (median age of 10.5 y) diagnosed as confirmed scrub typhus (ST) by using a lgM ELISA commercial kit (InBiOS International Inc. USA).

Methods

This was a prospective observational study conducted at a tertiary care hospital, over a period of 7 mo through April 2014. All the patients with undifferentiated febrile illness (aged 1–18 y) with fever of 5–21 d duration were evaluated. After thorough physical examination they were subjected to blood investigations such as complete blood count (CBC), blood culture, hepatic and kidney function tests, serum electrolytes, cerebrospinal fluid (CSF) analysis and IgM ELISA for scrub typhus, coagulogram and chest radiograph, wherever indicated.

Results

During this period, of the total 81 confirmed cases based on a positive scrub IgM ELISA and/or eschar, 6 (7.4 %), had neurological involvement in the form of presence of neck stiffness, altered sensorium and/or seizures and the CSF findings were suggestive of meningoencephalitis and all had evidence of multiple organ dysfunction syndrome (MODS) needing intensive care. The CECT could be performed in four patients only showing evidence of effacement of sulci and evidence of brain edema.

Conclusions

This communication highlights that variable central nervous system (CNS) involvement is not uncommon in patients with scrub typhus with high mortality. CSF and neuro-radiology findings are nonspecific as these are also observed in patients with aseptic meningitis or encephalitis. Early suspection and institution of appropriate therapy without delay will lead to substantial reduction in the morbidity and mortality.

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Acknowledgments

The authors acknowledge the support of the parents of the children and the residents and consultants and paramedics of the associated departments.

Contributions

AKS: Planning, conceptualization, editing, final analysis and submission of the manuscript; LC and HG: Enrollment, collection and analysis of data and follow-up. AKS will act as guarantor for the paper.

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Authors and Affiliations

  1. Department of Pediatric & Adolescent Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, 171001, India

    Ashwani Kumar Sood, Lokesh Chauhan & Hemant Gupta

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  1. Ashwani Kumar Sood
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  2. Lokesh Chauhan
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  3. Hemant Gupta
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Correspondence to Ashwani Kumar Sood.

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Sood, A.K., Chauhan, L. & Gupta, H. CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India. Indian J Pediatr 83, 634–639 (2016). https://doi.org/10.1007/s12098-015-2001-2

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  • DOI: https://doi.org/10.1007/s12098-015-2001-2

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