Scrub Typhus: A Clinico-Laboratory Differentiation of Children with and without Meningitis

Abstract

Neurological involvement in the form of meningitis or meningoencephalitis, although well documented in scrub typhus, has not been extensively studied in the pediatric population. We report the clinical and laboratory profile of 96 children with scrub typhus and compared those with and without meningitis. Twenty seven (28%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), meningeal signs (66.6%), nausea and vomiting (56.3%), seizures (55.5%) and altered sensorium (51.8%). The children with meningitis presented early and had significantly lower respiratory and renal impairments when compared with the non-meningitis group. Cerebrospinal fluid (CSF) analysis revealed elevated total leukocyte count (86.73 ± 94.50 cells/mm(3)), mononuclear pleocytosis (lymphocyte percentage of 76.85 ± 15.86), elevated proteins (108.33 ± 52.63 mg%) and normal CSF glucose (64.18 ± 15.92 mg%). We conclude that meningitis is a common and early complication of childhood scrub typhus. The CSF reveals a lymphocytic pleocytosis, raised proteins and a normal glucose level. These children respond promptly to appropriate antibiotics as do children without meningitis.

Clinical profile and seroepidemiology of scrub typhus and its concurrent infections associated with other tropical fevers: a two-year study from a tertiary care centre in North India

“…The commonest presenting symptoms being high grade fever with chills, shortness of breath and myalgia, headache and jaundice which are in accordance to the earlier studies. 1,[10][11][12][13][14] The percentage of patients presenting with altered sensorium and seizures was 11.6% and the pathognomonic eschar was seen in 11.8% of the patients, which is similar to that in the previous studies. 1,10,[12][13][14] Thirty-seven patients had elevation of serum transaminases, without evidence of any multiorgan dysfunction.…”

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

“…The duration of fever and prodromal stage was significantly longer in the scrub typhus group and vice versa in the non–scrub typhus group composed of Japanese encephalitis, other viral encephalitides, cerebral malaria, dengue encephalopathy, etc, which are of acute or hyper-acute onset. Another pediatric study, however, concluded a similar duration of fever (8.4 days), 17,18 although an adult study reiterated our finding of a longer duration of fever in scrub typhus than bacterial meningitis. 19 However, fever duration as short as 3 days in scrub typhus has also been documented.…”

“…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.…”

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

“…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.…”