Aseptic meningitis as a delayed neurologic complication of murine typhus

Vallejo-Maroto, I.; García-Morillo, Salvador; Wittel, Máximo Bernabéu; Stiefel, Pablo; Ml, Miranda Guisado; Pamies, E.; Aparicio, Reyes Jiménez; Carneado, J

doi:10.1046/j.1469-0691.2002.00502.x

Cited by 19 publications

(13 citation statements)

References 8 publications

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“…In the present study, the mortality of patients with meningoencephalitis was not high, in accordance with previous studies (23,24). However, central nervous system involvement was a factor associated with treatment failure, and treatment failure seemed to be more frequent in patients treated with doxycycline, based on some case reports (25,26). In our study, doxycycline was administered orally because the intravenous form is not available in the Republic of Korea and many other countries.…”

Section: Discussionsupporting

confidence: 90%

Outcome of Intravenous Azithromycin Therapy in Patients with Complicated Scrub Typhus Compared with That of Doxycycline Therapy Using Propensity-Matched Analysis

Jang

Kim

et al. 2014

Antimicrob Agents Chemother

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. No difference was observed in the time to defervescence or length of hospital stay between the two groups (P > 0.05). In complicated scrub typhus patients (n ‫؍‬ 181), multivariate analysis showed that only APACHE II score was an independent risk factor for mortality (95% confidence interval, 1.11 to 1.56; P < 0.001). Our data suggest that outcomes of azithromycin therapy are comparable to those of doxycycline therapy in patients with complicated scrub typhus.

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Section: Discussionsupporting

confidence: 90%

Outcome of Intravenous Azithromycin Therapy in Patients with Complicated Scrub Typhus Compared with That of Doxycycline Therapy Using Propensity-Matched Analysis

Jang

Kim

et al. 2014

Antimicrob Agents Chemother

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“…There are three possible explanations for therapeutic failure of doxycycline: 1) its bacteriostatic action, 2) difficulty in penetrating through the blood brain barrier and the resulting low concentrations in the CNS, and 3) resistance to the drug. 13 The rate of penetration of doxycycline into the brain or CSF is only 15-30% of that into the bloodstream. [14][15][16] A study of doxycycline concentrations in the CSF, 4 reported that 5-8 days after the start of therapy in Lyme neuroborreliosis, doxycycline concentrations above the minimum inhibitory concentration for Borrelia burgdorferi (0.6 μg/mL) were present in nine of 10 patients treated orally with doxycycline 200 mg bid, but in only three of 12 patients treated orally with doxycycline 100 mg bid.…”

Section: Discussionmentioning

confidence: 99%

Scrub Typhus Meningitis or Meningoencephalitis

Kim

Chung²,

Yun³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Orientia tsutsugamushi induces vasculitis leading to symptoms of systemic organ invasion including meningitis and meningoencephalitis. We conducted a retrospective case-control study of scrub typhus patients to investigate the clinical and laboratory features of patients with scrub typhus meningitis or meningoencephalitis, and the therapeutic outcomes, and to determine the predictor factors. Cases were 22 patients with scrub typhus meningitis or meningoencephalitis, and controls were 303 patients without meningitis or meningoencephalitis. Multivariate analysis showed that the presence of pneumonitis was associated with the occurrence of scrub typhus meningitis and meningoencephalitis (odds ratio [OR] 8.9; P 0.001; confidence interval [CI] 2.9-27.2). Although appropriate antimicrobials such as doxycycline agents were administered at an early stage, meningitis or meningoencephalitis still occurred in some cases. Physicians should be aware that meningitis or meningoencephalitis may develop during appropriate drug therapy such as doxycycline. Close observation and great care are essential for patients with risk factors, particularly pneumonitis.

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“…[13][14][15] Patients with murine typhus involving the central nervous system typically present with headache, fever, and neck stiffness 10 days to 3 weeks after the initial onset of febrile illness. 16,17 More serious neurological signs, such as diplopia, papilledema, and facial paralysis have also been reported. [17][18][19] Here, we report two patients with murine typhus who developed aseptic meningitis with sixth nerve palsy.…”

Section: Introductionmentioning

confidence: 99%

“…16,17 More serious neurological signs, such as diplopia, papilledema, and facial paralysis have also been reported. [17][18][19] Here, we report two patients with murine typhus who developed aseptic meningitis with sixth nerve palsy.…”

Section: Introductionmentioning

confidence: 99%

Abducens Nerve Palsy and Meningitis by Rickettsia typhi

Moy

Ooi

2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Patients with rickettsial infection may present with encephalitis or meningitis but neurologic involvement is rare in murine typhus. Here, we report two patients with Rickettsia typhi meningitis who presented with cranial neuropathy, presumably caused by two distinct disease processes. Recognition of the disease manifestations is important because rickettsial infections are potentially associated with significant morbidity. Simple effective treatments are available.

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Aseptic meningitis as a delayed neurologic complication of murine typhus

Cited by 19 publications

References 8 publications

Outcome of Intravenous Azithromycin Therapy in Patients with Complicated Scrub Typhus Compared with That of Doxycycline Therapy Using Propensity-Matched Analysis

Outcome of Intravenous Azithromycin Therapy in Patients with Complicated Scrub Typhus Compared with That of Doxycycline Therapy Using Propensity-Matched Analysis

Scrub Typhus Meningitis or Meningoencephalitis

Abducens Nerve Palsy and Meningitis by Rickettsia typhi

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