Neurological Manifestations of Scrub Typhus

Basu, Suman; Chakravarty, Ambar

doi:10.1007/s11910-022-01215-5

Cited by 21 publications

(17 citation statements)

References 56 publications

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“…The copyright holder for this preprint (which was not certified by peer review) is the this version posted April 25, 2023. ; https://doi.org/10.1101/2023.04.21.23288926 doi: medRxiv preprint prevalence in the community. Eschar, though described as the "cutaneous hallmark" [35] is not always present in all the infected individuals [3]; thus lowering the suspicion index (a key to early diagnosis) [14,36]. The prevalence of eschar ranges from 7-80% [8] and is low in South East Asia and India [6].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India

Vanramliana

Pautu

Lalmalsawma³

et al. 2023

Preprint

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In the last decade, there has been an emergence of scrub typhus in many parts of India. In Mizoram, North-East India, there has been a steep increase in scrub typhus and other rickettsial infections in the last 5 years. As part of the public health response, the Mizoram Government has integrated screening (by rapid immunochromatographic test and/or Weil-Felix test) and line listing of scrub typhus and other rickettsial infections across all its health settings, a first in India. From 2018-22 (study period), 22914 cases were reported; of these, 19651 were positive for scrub typhus. Aizawl district is the worst affected, with 10580 cases (46.17%). The average incidence rate of rickettsial infections is 3.54 cases per 1000 persons-year, and the case fatality rate is 0.35. Patients with eschar (aOR=2.5, p<0.05), construction workers (aOR=17.9, p<0.05), and children aged 10 and below (aOR=5.4, p<0.05) have higher odds of death due to rickettsial infections.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India

Vanramliana

Pautu

Lalmalsawma³

et al. 2023

Preprint

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“…In addition, patients with severe scrub typhus can present with encephalitis, meningoencephalitis, acute kidney failure, acute respiratory distress syndrome, diffuse intravascular coagulation, multiorgan failure, infectious shock, and even death. [18,19].About 6% of people with scrub typhus die if not treated aggressively. Patients with severe scrub typhus have higher mortality rates, with rates as high as 14% and 24% for patients with scrub typhus combined with encephalitis and multiple organ failure.…”

Section: Discussionmentioning

confidence: 99%

Severe fever with thrombocytopenia syndrome: comparison with scrub t yphus first clinical features and blood and physiological and biochemical indices

Liu,

Chu,

Gong

et al. 2023

Preprint

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Background To explore differences in epidemiology, initial clinical characteristics, routine blood and physiological and biochemical indices between Severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus(ST) patients with the aim of providing evidence for early diagnosis and treatment. Methods Between February and November 2022, a total of 122 cases of SFTS and 22 cases of ST were confirmed in the laboratory of hospitals in the provinces of Hefei, Anqing and Liuan, Anhui. Results The early clinical features showed that headache, generalized pain, cutaneous petechiae and ecchymosis, loss of appetite, skin rash, and specific crusts and ulcers were more pronounced in ST patients compared with SFTS patients, and only diarrhoea was more pronounced in SFTS patients compared to ST patients and the difference was found to be statistically significant (P < 0.05). Blood regular indexes showed that the WBC, LYMPH, MONO, NEUT, and PLT counts were significantly reduced in SFTS patients as compared to the ST patients, and all were below the normal range in the SFTS group, while ST all fell within normal ranges, and the differences were all found to be statistically significant (P < 0.05). However,WBC, LYMPH and P-LCR were within normal values. Physiologic and biochemical results showed that SFTS patients had lower TBIL, IBIL, ALT, Ga+, BUN, CREA, CRP, PCT, TT, PT, and TNR counts than ST patients. CK, CK-MB, LDH, UA and AG were significantly higher in SFTS patients compared to ST patients and the differences were found to be statistically significant (P < 0.05). However, TBIL, IBIL, CK-MB, Ca2+ counts were in the normal range in both groups. Conclusion Diarrhea was more pronounced and myocardial injury was more severe in SFTS patients, while scab or ulcer disease, impaired liver and kidney function, and inflammatory response were more pronounced in ST patients.

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“…Meningitis complications are well known, and other acute disseminated encephalomyelitis, cranial nerve damage, cerebral vascular disease including cerebral venous sinus thrombosis, transverse myelitis, nystagmus, and GBS have also been reported. [5] There are several case reports of GBS occurring after scrub typhus. [6][7][8][9] Unfortunately, however, no clear pathological mechanism has been elucidated other than the temporal relationship.…”

Section: Discussionmentioning

confidence: 99%

Two possible etiologies of Guillain-Barré syndrome: mRNA-1273 (Moderna) vaccination and scrub typhus: A case report

Hwang

Bong

2022

Medicine

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Rationale: Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy related to infection with bacteria or virus and vaccination. Cases of GBS after coronavirus infection-19 (COVID-19) vaccination have been reported. However, cases of GBS after inoculation with mRNA-based COVID-19 vaccines, especially mRNA-1273, have rarely been reported compared to after inoculation with adenovirus vector-based COVID-19 vaccines. On 1 hand, GBS occurring after scrub typhus is often reported, but the exact pathological mechanism has not been elucidated. We report the case of a patient with GBS after inoculation with mRNA-1273 COVID-19 vaccine and scrub typhus.Patient concerns: A 47-year-old man received COVID-19 vaccination 4 weeks before admission. He had a fever, rash and general weakness 1 day after vaccination. After 3 weeks, the muscle strength of the extremities deteriorated to the extent that walking was impossible. Diagnosis, interventions, and outcomes:The patient developed quadriplegia with areflexia, axonal-type sensorimotor polyneuropathy was confirmed by nerve conduction study. The patient was diagnosed as GBS. Scrub typhus was also diagnosed as eschar was observed in the chest area and the serologic test of anti-R-tsutsugamushi antibody showed a strongly positive result. The patient received treatment with intravenous immunoglobulin at 0.4 g/kg daily for 5 days. Mechanical ventilation was applied during the intensive care unit. He was treated for scrub typhus simultaneously. Six months after the onset of the disease, the patient showed improvement to the point where he could work and exercise alone.Lessons: When GBS is suspected, early evaluation and treatment can lead to favorable outcomes. Considering that cases of GBS after COVID-19 vaccination have been reported, it is important to conduct early evaluation and management of patients with muscle weakness after COVID-19 vaccination to ensure early detection of GBS. And even if fever and rash are side effects that can occur frequently after vaccination, it is necessary to consider other diseases in addition to the side effects of the vaccine. This is to prevent delay in diagnosis and treatment of other diseases.

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Neurological Manifestations of Scrub Typhus

Cited by 21 publications

References 56 publications

Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India

Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India

Severe fever with thrombocytopenia syndrome: comparison with scrub t yphus first clinical features and blood and physiological and biochemical indices

Two possible etiologies of Guillain-Barré syndrome: mRNA-1273 (Moderna) vaccination and scrub typhus: A case report

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