Neurological manifestations of scrub typhus

Abstract

Meningoencephalitis/encephalopathy may be seen in two-third of patients with scrub typhus. Scrub typhus should be included in the differential diagnosis of febrile encephalopathy.

Scrub Typhus Meningoencephalitis

“…Eschar is found in 7-80% patients of scrub typhus [3]. In the authors study, eschar was detected in 28.81% of the patients of scrub typhus and 30.77% patients of meningoencephalitis due to scrub typhus [6]. The wide range of detection may be due to the difficulty in detecting eschars in dark-skinned individuals, difference in the eschar inducing capacity of the different strains of O. tsutsugamushi.…”

“…By this, it was suggested that the Karp and Boryong genotypes possibly invade the CNS more than other types [4]. In the author's study, tuberculous meningitis remained the close differential diagnosis of scrub typhus meningitis due to similar CSF findings [6]. However, CSF adenosine deaminase (ADA) may be helpful, as it is elevated >10 in tuberculous meningitis, unlike scrub typhus meningitis.…”

“…These meningeal signs are detected in upto 45% patients. In the author's study, meningeal signs were present in 76.92% patients [6].…”

“…In the authors study [6] neurological manifestations were associated with lymphadenopathy (46.15%), jaundice (53.85%), pulmonary oedema (23.08%), oliguria (15.38%), hepatomegaly (38.46%) and splenomegaly (7.69%). Multi-organ dysfunction was found in 15.38% patients of scrub typhus with neurological manifestation.…”

“…Meningitis or meningoencephalitis can occur in upto one-fifth of affected patients. In the authors study, meningoencephalitis was found in 13.2% of scrub typhus patients [6]. The various neurological manifestations of scrub typhus [5] are as given in (Table 1).…”