Acute Parkinsonism and Cerebral Salt-wasting-related Hyponatremia in Scrub Typhus

Soundararajan, Sunitha; Viswanathan, Stalin; Jain, Dheeraj; Krishnamurthy, Vijayalatchumy; Gayathri, Murugesan Sivagurunathan

doi:10.7759/cureus.6706

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Approximately 20%–25% of patients with scrub typhus suffer from neurological complications, making this an important part of the clinical constellation. [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 ...…”

Section: R Esultsmentioning

confidence: 99%

Neurological Facets of Scrub Typhus

Garg¹,

Manesh

2021

Annals of Indian Academy of Neurology

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Scrub typhus is one of the most frequent causes of acute febrile illness in South and South-east Asian countries. Neurological features accompany 20% of scrub typhus infections, and may affect the central or peripheral nervous system, and sometime, may even occur in combination. Of late, its recognition among clinicians has increased with widening detection of its cutaneous hallmark, called eschar. Multiple mechanisms underlie neurological involvement, including direct invasion (meningitis, encephalitis), vasculitis (myositis) or immune-mediated mechanisms (opsoclonus, myoclonus, optic neuritis, Guillain–Barre syndrome). Despite an immunological basis for several neurological manifestations, response to doxycycline is remarkable, although immune therapy may be necessary for severe involvement. Scientific literature on scrub typhus neurology chiefly emanates from case reports, case series and small studies, and a comprehensive review is warranted to aid clinicians in recognising neurological involvement. This review aims at enriching this gap, and summarises clinical features, laboratory findings, and treatment options for various neurological facets of scrub typhus.

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Section: R Esultsmentioning

confidence: 99%

Neurological Facets of Scrub Typhus

Garg¹,

Manesh

2021

Annals of Indian Academy of Neurology

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“…7 Cerebral salt wasting (CSW) is rarely encountered with scrub typhus. 4,8 The presence of hypovolaemic hypo-osmolar hyponatremia favors cerebral salt wasting as opposed to a syndrome of inappropriate antidiuretic hormone secretion where patients are euvolemic. 8 The treatment of CSW involves volume repletion and sodium replacement.…”

Section: Discussionmentioning

confidence: 99%

Case report of scrub typhus with bilateral acute sensorineural hearing loss and cerebral salt-wasting disease

Goonetilleke,

Silva

2023

Trop Doct

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Scrub typhus is a re-emerging and endemic disease in the Asia Pacific region caused by Orientia tsutsugamushi. We present a 65-year-old male from Sri Lanka who presented with fever, bilateral acute sensorineural hearing loss, and confusion. On examination, he was dehydrated. Significant orthostatic hypotension and an eschar were noted. Investigations revealed hyponatremia with elevated urine sodium, reduced serum osmolality, and normal urine osmolality suggestive of cerebral salt wasting. After initial hydration with 0.9% NaCl, hyponatremia was corrected with 3% NaCl. Oral doxycycline was prescribed, and he showed dramatic clinical improvement. A diagnosis of typhus must be considered in a patient presenting with a febrile illness and acute hearing loss. Cerebral salt-wasting disease should be considered in a patient with typhus who develops hyponatremia with dehydration. Furthermore, acute sensorineural hearing loss in both ears is an important manifestation of the disease.

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“…meningitis, meningoencephalitis, cranial neuropathies, plexopathies, acute disseminated encephalomyelitis, Guillain-Barré syndrome, transverse myelitis, cerebral infarction, subarachnoid hemorrhage, cerebral venous sinus thrombosis, seizures, parkinsonian symptoms, coma, cerebellitis, psychiatric symptoms and cerebral salt wasting syndrome, among others). 2-5,10,11 Clinical features may result either from direct damage to an area leading to altered functioning of that region or may be immune-mediated. As in our case, the focal seizures with dyscognitive features and the cognitive decline were due to the affection of medial temporal lobes.…”

Section: Discussionmentioning

confidence: 99%

Scrub Typhus Masquerading as Limbic Encephalitis

Biswas

Ghosh

Roy

et al. 2021

The Neurohospitalist

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Scrub typhus, an acute febrile infectious disease prevalent in the ‘tsutsugamushi triangle’, is a mite-born rickettsial zoonosis, caused by Orientia tsutsugamushi. The clinical presentation is protean and involves multiple organ systems of the body, including central and peripheral nervous systems. We report a 22-year-old previously healthy Indian woman who presented with clinical (confusion, excessive sleepiness, cognitive dysfunction and focal seizures) and neuroimaging features of limbic encephalitis. After exclusion of common infectious, autoimmune and paraneoplastic causes, she was diagnosed with scrub typhus associated encephalitis, which responded to doxycycline and azithromycin therapy.

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Acute Parkinsonism and Cerebral Salt-wasting-related Hyponatremia in Scrub Typhus

Cited by 4 publications

References 7 publications

Neurological Facets of Scrub Typhus

Neurological Facets of Scrub Typhus

Case report of scrub typhus with bilateral acute sensorineural hearing loss and cerebral salt-wasting disease

Scrub Typhus Masquerading as Limbic Encephalitis

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