Scrub Typhus Meningitis in South India — A Retrospective Study

Abstract

BackgroundScrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reportsMethodsA retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness- a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits.ResultsSixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol.ConclusionMeningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.

A study on demographic, clinical profile and outcome of scrub typhus

“…MODS were reported as high as 50% of patients without meningoencephalitis and 76.5% with meningoencephalitis. 19 In our study MODS was present in 7%, meningoencephalitis in 1% and ARDS in 11% patients though other study reported meningoencephalitis as a more common complication (26%) and ARDS incidence same as present study (11.1%). 20 The case fatality rate was 6% of which the most common cause was MODS, followed by ARDS.…”

Scrub typhus, a reemerging zoonosis – An Indian case series

“…4 Medical records of patients were reviewed. The clinical manifestations, investigations and outcomes were analyzed.…”

Scrub Typhus Meningoencephalitis

“…It is widespread in the so-called 'tsutsugamushi triangle' which extends from Pakistan, India, Nepal in the West, to South Eastern Siberia, Japan, China and Korea in the North, to Indonesia, the Philippines, Northern Australia and the Pacific islands in the South. Taiwan is the centre of the tsutsugamushi triangle, and Korea has the highest reported incidence in the world [2]. About one million new cases are identified annually.…”

“…The eschar not only has immense diagnostic relevance but is also important prognostically. Absence of an eschar is a risk factor for mortality [2].…”

“…Most commonly sixth nerve involvement is seen, which maybe unilateral or bilateral. Facial palsy may occur in isolation or in association with Guillain Barre syndrome [2]. Cochlear nerve involvement occurs in about 19% patients and cause sensorineural hearing loss, otalgia and tinnitus.…”