Neurological manifestations of scrub typhus in adults

Abstract

In order to study the neurological manifestations in adult patients suffering from scrub typhus, 323 patients aged over 18 years, admitted with a positive diagnosis, were screened for neurological dysfunction; 37 patients with symptoms and/or signs suggestive of neurological dysfunction were included in the study. Of these, 31 (84%) patients had altered sensorium, four (11%) had cerebellitis, one (2%) patient had acute transverse myelitis and one (2%) had bilateral papilloedema without focal neurological deficit. Of the 31 patients with altered sensorium, 15 (40%) had meningoencephalitis, three (8%) had seizures, two (5%) had cerebral haemorrhages, one (2%) had a presentation likened to neuroleptic malignant syndrome (NMS) and one (2%) had a 6th nerve palsy with inflammation of the right cavernous sinus. Cerebrospinal fluid (CSF) analysis was abnormal in 23 patients (raised lymphocytes in 68%, raised protein in 80%). All patients improved with anti-rickettsial therapy.

Type 1-skewed neuroinflammation and vascular damage associated with Orientia tsutsugamushi infection in mice

“…CNS alterations are evident in scrub typhus patients [7,8,9], in a mouse self-limiting model [15], and in our studies herein. However, Orientia antigens in mouse brains seems sparse (Fig 5)[17], often 50-200-fold less in bacterial gene copies than in the lungs [15,17].…”

“…Disease severity and mortality are associated with increased endothelial and macrophage markers [4]. CNS involvement is common among severe cases, and diverse neurological symptoms, including headache, vomiting, altered sensorium, seizures, have been reported [5,6,7,8,9]. Patients can be categorized into meningitis, encephalopathy, and encephalitis, based on neck stiffness, consciousness level, and cerebrospinal fluid cell count, as well as other pathological evidence of focal neurological deficits [10,11,12].…”

Neuropsychiatric Manifestations of Scrub Typhus

“…[15] A study by Rana et al reported a patient with bilateral papilledema without focal deficit with normal brain imaging. [13] Cho et al reported bilateral optic neuritis with scrub typhus. [16] Rana et al, Kim et al, and Lee et al described 6 th nerve palsy in patients suffering from scrub typhus.…”

“…Of these, 31 (84%) patients had altered sensorium, 15 (40%) had meningoencephalitis, 3 (8%) had seizures. [13] Acute disseminated encephalomyelitis Chen et al reported a 77-year-old man admitted with fever, convulsions, and an altered level of consciousness. On neurological examination, he was stuporous with nuchal rigidity and had left hemiparesis.…”

“…[16] Rana et al, Kim et al, and Lee et al described 6 th nerve palsy in patients suffering from scrub typhus. [13,17,18] A 49-year-old man who had fever, malaise, headache, oliguria, and tea-colored urine. Bilateral pneumonitis, acute renal failure, acalculous cholecystitis, and aseptic meningitis were diagnosed after a series of examinations.…”