Clinical Spectrum and Outcome of Acute Encephalitis Syndrome in Children with Scrub Typhus: A Series of Eight Cases from India

Abstract

A bstract Scrub typhus has reemerged with a different geographical distribution and varied clinical presentation like acute encephalitis syndrome (AES), which is a less known entity in scrub typhus. In this case series, we studied the clinical profile and outcome of eight patients who presented with AES and a positive scrub serology without any other identifiable cause of encephalopathy. All these patients had fever, altered sensorium, and nuchal rigidity, while seizures were present in six (75%) patients and papilledema in two (25%) patients. Complications like shock, pulmonary edema, and gastrointestinal (GI) bleed were observed in three (37%) patients. All patients except for one responded well to the treatment and recovered completely. Scrub typhus should be suspected early in patients presenting with AES. How to cite this article: Kaur P, Jain R, Kumar P, Randev S, Guglani V. Clinical Spectrum and Outcome of Acute Encephalitis Syndrome in Children with Scrub Typhus: A Series of Eight Cases from India. Indian J Crit Care Med 2020;24(9):885–887.

Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India

“…This testing could have a notable effect on the approach to clinical management and public health interventions for patients with AES. Apart from reinforcing common clinical, epidemiologic, and laboratory findings reported by other studies (13,29,39,40,46), we report insights into the neurologic spectrum of scrub typhus in children, which appears to be broad and underreported.…”

“…The neurologic manifestations in children with scrub typhus that meet the broader epidemiologic definition of AES are rarely reported (13,25,39,40), and no data from southern India have been published. Of all children with scrub typhus in our study, 8 (9%) had involuntary hyperkinetic movements that are rare neurologic manifestations of scrub typhus more often reported in adults than children (41).…”

An alarming surge of scrub typhus cases presenting as acute encephalitis in children

“…[18][19][20][21] In a case series of eight children with scrub encephalitis, seven patients responded well to doxycycline treatment, and recovered completely while one patient died because of refractory shock. 22 However, drug-resistant strains are now emerging; this is a matter of concern.…”

Scrub typhus Meningoencephalitis : Diagnostic dilemma

“…Some studies have reported usefulness of CSF adenosine deaminase for the differentiation but its definite role is not proven. Neurological involvement in scrub typhus is associated with different neuroimaging findings ranging from normal imaging to abnormalities like cerebral edema, features of ischemic changes, small ring enhancing lesions in the corpus callosum, and hyperintensities in periventricular and deep white matter regions of the brain 5 .…”