Central Nervous System Involvement in Patients with Scrub Typhus

Abstract

Scrub typhus, which is caused by Orientia tsutsugamushi, is a systemic illness that causes generalized vasculitis. The central nervous system (CNS) is the most crucial target in other rickettsial diseases; however, there have been several reports of encephalitis or meningitis without direct evidence of rickettsial invasion of the CNS in cases of scrub typhus. To investigate CNS involvement in cases of scrub typhus, we analyzed the CSF profiles (cell count and levels of protein and glucose) and amplified rickettsial DNA in CSF specimens by means of nested polymerase chain reaction (PCR) for 25 patients with the infection. Mild pleocytosis was present in 48% of the patients: CSF white blood cell counts ranged from 0 to 110/mm3 (mean [+/- SD] count, 16.3 +/- 27.0/mm3), and the mean (+/- SD) lymphocyte proportion was 51.9% +/- 23.9%. The CSF protein level was increased (>50 mg/dL) in seven patients. Nested PCR amplified six products from the 25 CSF specimens: four of the products were Boryong genotypes, and two were Karp genotypes. The results of this study suggest that O. tsutsugamushi does invade the CSF and that scrub typhus should be considered one of the causes of mononuclear meningitis in areas of endemicity.

Severe Condition of Scrub Typhus Meningo-Encephalitis in a Child:A Case Report from Delhi, India

“…In this case elevated level of CSF proteins, which was an indication of this disease, helps us in differential diagnosis. The same pattern was observed in the report of Pai et al [21].…”

Does the presence of an eschar correlate with severity of scrub typhus infection?

“…CNS involvement is often a prominent clinical manifestation of ST infection and aseptic meningitis occurs in 12.5-26% of affected patients. [7,14,15] Some studies have shown altered sensorium to be an independent platelet count<100,000/cells cu mm), leucopenia (total WBC count<2500/cells cu mm), leucocytosis (total WBC count>11,000/cells cu cc) or evidence of coagulopathy; Renal involvement: Serum creatinine>2 mg/dL or need for dialysis; CVS involvement: Hypotension or need for inotropic or vasopressor support; CNS involvement: Alteration in the level of consciousness or aseptic meningitis; Hepatic involvement: Serum bilirubin>2 mg/dL or three fold elevation of SGOT/SGPT or elevated ALP; GI involvement: GI bleed; Respiratory involvement: PaO2/FiO2 ratio<300 or need for ventilator assistance. OR=Odds ratio, CI=Confidence interval, WBC=White blood cell, CVS=Cardiovascular system, CNS=Central nervous system, SGOT=Serum glutamic oxaloacetic transaminase, SGPT=Serum glutamic-pyruvate transaminase, ALP=Alkaline phosphatase, GI=Gastrointestinal, RS=Respiratory system predictor of mortality.…”

Abducens Nerve Palsy and Meningitis by Rickettsia typhi

“…The presence of rickettsial DNA in CSF samples can also be detected using nested PCR, but the sensitivity and specificity of this technique is yet to be determined. 41,42 Antimicrobial therapy is highly effective in rickettsioses if initiated early in the first week of illness. 43 Treatment should be started early in suspected rickettsial infections and should not await confirmatory testing.…”