Comparison of Scrub Typhus With and Without Meningitis

Rose, Winsley; Ghosh, Urmi; Punnen, Anu; Sarkar, Rajiv; Prakash, John Jude; Verghese, Valsan Philip

doi:10.1007/s12098-017-2403-4

Cited by 11 publications

(12 citation statements)

References 20 publications

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“…In the present study, cerebrospinal fluid protein level was significantly higher in the scrub typhus vs the non–scrub typhus group (110 vs 66.7). Other studies have reported moderately elevated protein, lymphocytosis, and normal glucose in the cerebrospinal fluid in scrub typhus meningoencephalitis, 8,18,19,30,32 although 1 study documented hypoglycorrhachia. 33 Longer duration of illness and elevated cerebrospinal fluid protein with lymphocytic pleocytosis makes tubercular meningitis the closest differential diagnosis in our setting.…”

Section: Discussionmentioning

confidence: 90%

Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India

et al. 2020

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Objectives: To evaluate the proportion of scrub typhus meningoencephalitis among children with acute encephalitis syndrome and to outline its differentiating features. To develop a prediction rule for scrub typhus meningoencephalitis. Methods: A prospective cohort study was conducted at a tertiary care public hospital in Northern India. Consecutive patients of acute encephalitis syndrome who met our inclusion criteria were enrolled over 2 years. Standardized workup including serum IgM against Orientia tsutsugamushi was performed. Clinical and laboratory features were compared between IgM-positive and IgM-negative patients. The area under the receiver operating characteristic curve of the score derived from “independent predictors” was measured. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated at different cut-offs of the score. Results: Scrub typhus IgM enzyme-linked immunosorbent assay was positive in 66/352 patients (18.8%). Longer duration of fever and prodromal stage along with eschar, hepatomegaly, lymphadenopathy, and pneumonia were significantly more prevalent in scrub typhus meningoencephalitis. However, petechiae were frequent in non–scrub typhus patients. Leucocytosis, lymphocytosis, thrombocytopenia, hypoalbuminemia, and elevated levels of serum bilirubin, serum transaminases, and cerebrospinal fluid protein were associated with scrub typhus meningoencephalitis. Logistic regression revealed fever for >8 days, pneumonia, absence of petechiae, cerebrospinal fluid protein >1000 mg/L, and serum glutamic oxaloacetic transaminase >100 IU/L as independent “predictors” of scrub typhus meningoencephalitis. The area under the receiver operating characteristic curve (95% confidence interval) of the prediction score was 0.832 (0.78-0.89). Score at cutoff ≥1 had 91% sensitivity, 96.1% negative predictive value, and at cutoff ≥4 had 99.7% specificity, 88.9% positive predictive value, 83.1% negative predictive value, 40.3 positive likelihood ratio, 0.88 negative likelihood ratio for identifying scrub typhus meningoencephalitis. Conclusion: Prediction score may help physicians in peripheral areas to identify and treat scrub typhus meningoencephalitis, an emerging cause of acute encephalitis syndrome in India.

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Section: Discussionmentioning

confidence: 90%

Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India

et al. 2020

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“…Our findings were similar to other studies published in children from other parts of India. 5,7 Of various clinical features of meningitis, headache was noted in 62.5% and vomiting in 50% patients. Other pediatric studies have found headache in <50% children, though headache is seen in >60% of adults with STM.…”

Section: Discussionmentioning

confidence: 99%

Profile of Scrub Typhus Meningitis/Meningoencephalitis in Children with and without Scrub Typhus IgM Antibody in CSF

Behera

Satapathy

Ranjan

et al. 2021

JNRP

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The aim of this article was to study the spectrum of scrub typhus meningitis/meningoencephalitis (STM) cases in children. Children ≤14 years of age with acute undifferentiated febrile illness were included. Immunoglobulin M (IgM) enzyme-linked immunosorbent assay was done in blood and cerebrospinal fluid (CSF) of children with suspected STM. Demographic, clinical, and laboratory details were expressed as descriptive statistics. Factors associated with neurological involvement were identified on univariate analysis. A total of 76 children had ST during the study period (meningitis/meningoencephalitis = 8 [10.5%], of which 5 [62.5%] had detectable ST IgM antibodies in CSF). The included children were 4 to 12 years of age with boys > girls. Headache and vomiting were common in those with STM, whereas hyponatremia and thrombocytopenia were common in those without STM. All children with STM recovered with sequelae in one child (right lateral rectus palsy). There was no mortality. STM has an incidence of 10.5% in children with ST from Eastern India. Headache and vomiting were significant predictors of STM, whereas hyponatremia and thrombocytopenia were significant predictor of non-STM.

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“…The exclusion criteria in this study were as follows: children using long-term medications, immunodeficiency, and have a chronic disease. Severity of the disease was defined based on previously published adult and pediatric studies (7)(8)(9)(10)(11)(12)(13). The study population was divided into two groups in terms of disease severity: (1) non-severe, patients without any complications and (2) severe, patients with severe complications.…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Predictors of Severity of Pediatric Scrub Typhus in a Tertiary Level Hospital in South India

Elayaraja

Rajan

Pasupathy

et al. 2020

Arch Pediatr Infect Dis

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Background: Scrub typhus, a zoonosis caused by bacteria Orientia tsutsugamushi is associated with varying clinical features and significant mortality due to complication in view of ineffective treatment. Objectives: This study was undertaken to identify the factors for predicting severity in scrub typhus. Methods: This retrospective study was conducted at a tertiary care teaching hospital between January 2015 to October 2016. All children younger than 18 years of age admitted with a history of fever for more than seven days and positive IgM ELISA for scrub typhus were included in the study. Cases of "severe scrub typhus" were identified based on criteria from published pediatric studies. A total of 235 patients tested positive for scrub typhus, out of which 39 patients were in the severe scrub group and 196 in the nonsevere group. Reports were analyzed for the predictors of severity of scrub typhus in both groups. Results: Using multivariate analysis, the factors for predicting severity in scrub typhus were hemoglobin < 10 g/L (OR = 2.8, CI = 1.40 to 5.72), platelet < 150 000 cells/mm 3 (OR = 2.54, CI = 1.21 to 5.30), albumin < 2.5 g/d (OR = 3.18, CI = 1.42 to 7.11), SGOT > 5 fold rise (OR = 49.7, CI = 13.49 to 183.17), prolongation of PT (P value = 0.03), and altered sensorium (P value = 0.016) were correlated with severe disease. Conclusions: We conclude that altered sensorium, anemia, thrombocytopenia, elevated transaminases, hypoalbuminemia, and prolongation of prothrombin time to be predictors of severity of illness in scrub typhus.

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Comparison of Scrub Typhus With and Without Meningitis

Abstract: Meningitis occurs in 15% of those with scrub typhus; those with meningitis have good neurological outcome with little mortality; those without meningitis have more complications and poorer outcome.

Cited by 11 publications

References 20 publications

Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India

Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India

Profile of Scrub Typhus Meningitis/Meningoencephalitis in Children with and without Scrub Typhus IgM Antibody in CSF

Clinical Characteristics and Predictors of Severity of Pediatric Scrub Typhus in a Tertiary Level Hospital in South India

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