Acute encephalitis syndrome following scrub typhus infection

Abstract

Objective:The aim was to find the incidence of acute encephalitis syndrome (AES) secondary to scrub infection and to observe the clinical, biochemical, radiological profile, and outcomes in these patients.Materials and Methods:A total of 20 consecutive patients of AES were evaluated for scrub infection using scrub typhus immunoglobulin M enzyme linked immuno-sorbant assay positivity along with the presence or absence of an eschar. Clinical profile, routine laboratory tests, cerebrospinal fluid (CSF) analysis, and neuroimaging were analyzed. Patients were treated with doxycycline and followed-up.Results:Among 20 consecutive patients with AES, 6 (30%) were due to scrub infection. They presented with acute onset fever, altered sensorium, seizures. Eschar was seen in 50% of patients. CSF done in two of them was similar to consistent with viral meningitis. Magnetic resonance imaging brain revealed cerebral edema, bright lesions in the putamen and the thalamus on T2-weighted and fluid-attenuated inversion recovery sequences. Renal involvement was seen in all patients. All patients responded well to oral doxycycline.Conclusion:AES is not an uncommon neurological presentation following scrub typhus infection. It should be suspected in all patients with fever, altered sensorium, and renal involvement. Oral doxycycline should be started as early as possible for better outcomes.

Uncommon Manifestations of Scrub Typhus Encephalitis in Two Cases: Clinical and Magnetic Resonance Imaging Findings

“…Scrub typhus is usually limited to the gray matter because, pathologically, it involves small vessels throughout the body (7,9). Thus, scrub typhus rarely involves the white matter, and only a few reports have described cases of scrub typhus involving the white matter (3,7).…”

Severe scrub typhus infection: Clinical features, diagnostic challenges and management

“…Complications of scrub typhus infection include pneumonia [33] , acute respiratory distress syndrome (ARDS) like picture [34,35] , Peter JV et al . Scrub typhus infection myocarditis [36] , encephalitis [37] , hepatitis [38] , DIC [39] , hemophagocytic syndrome [40] , acute kidney injury [41] , acute pancreatitis [42] , transient adrenal insufficiency [43] , subacute painful thyroiditis [44] and presentation as an acute abdomen [45] . Several neurological manifestations have been observed in the setting of scrub typhus infection.…”

Scrub typhus meningoencephalitis, a diagnostic challenge for clinicians: A hospital based study from North-East India

“…Other reports of seizure in patients with CNS involvement in scrub typhus varies from 22% to 50%. [ 4 5 16 ] Myoclonus is a rare finding in scrub meningoencephalitis, and only one care is reported in the literature along with Parkinsonism. [ 17 ] In the present study, 1 patient (7.69%) had myoclonic jerky movement involving the lower limb.…”

“…Central nervous system (CNS) involvement is a known complication of scrub typhus which ranges from meningitis to frank meningoencephalitis. [ 4 5 ] The name “typhus” itself, is derived from the Greek word “typhos,” which means stupor. Other neurological complications include seizure, cranial nerve deficits, vasculitic cerebral infarct, brain hemorrhages, polyneuropathy, sensorineural hearing loss, meningitis or meningoencephalitis.…”