First case of scrub typhus with meningoencephalitis from Kerala: An emerging infectious threat

Abstract

Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi, one of the most common infectious diseases in the Asia-Pacific region. It has been reported from northern, eastern, and southern India, and its presence has been documented in at least 11 Indian states. However, scrub typhus meningoencephalitis has not been well documented in Kerala. We report two cases of scrub typhus meningoencephalitis from northern Kerala. The diagnosis was made based on the clinical pictures, presence of eschar, and a positive Weil–Felix test with a titer of > 1:320. The first patient succumbed to illness due to respiratory failure and the second patient improved well.

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

“…Tetracyclines (Doxycycline) and chloramphenicol is important in this context. This mode of treatment is also accepted by others [5]. A case report by Pai et alalso states that doxycycline therapy was started at very early stages.…”

“…In India, most of the times Scrub typhus is underdiagnosed because of the nonspecificity in the signs and symptoms, lack of awareness among medical practitioners and shortage of diagnostic facilities. The most common pathognomic clinical sign of scrub typhus is the presence of eschar in 40-50% of the cases in different areas of body, like groin, gluteal folds, breast folds, and external genitalia [5]. Patients with scrub typhus, may exhibit mild-to-moderate neurological symptoms, but CNS involvement in scrub typhus in the form of meningo-encephalitis in pediatric population is less known [5,6].…”

“…The most common pathognomic clinical sign of scrub typhus is the presence of eschar in 40-50% of the cases in different areas of body, like groin, gluteal folds, breast folds, and external genitalia [5]. Patients with scrub typhus, may exhibit mild-to-moderate neurological symptoms, but CNS involvement in scrub typhus in the form of meningo-encephalitis in pediatric population is less known [5,6]. Sometimes, clues to diagnosis like travel history from endemic region or presence of skin lesion at site of tick bite (eschar) is absent.…”

Scrub typhus, a reemerging zoonosis – An Indian case series

“…In our study we defined leukocytosis as white blood cells [WBC] >12000 cells/mm 3 , anemia as hemoglobin <10 g/dL, thrombocytopenia as platelets <1.5 lakhs/mm 3 , elevated bilirubin as total bilirubin >3 mg/dL, elevated aspartate aminotransferase and alanine aminotransferase as four times the normal and acute renal failure as creatinine >1.5 mg/dL. 5 This study was done after obtaining the approval from the institutional ethics committee.…”

“…Scrub typhus is rarely diagnosed in our country because of its nonspecific clinical presentation, low index of suspicion and lack of adequate diagnostic facilities. 3 The main aim of our study was to analyze the clinical features, lab parameters and outcome of patients diagnosed with Scrub typhus in our hospital.…”