Rare neurological and neuropsychiatric manifestations of scrub typhus: a case series of 10 cases

Ghosh, Ritwik; Mandal, Arpan; León-Ruiz, Moisés; Roy, Dipayan; Das, Shambaditya; Dubey, Souvik; Benito‐León, Julián

doi:10.1016/j.nrleng.2022.07.001

Cited by 5 publications

(16 citation statements)

References 57 publications

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“…Orientia tsutsugamushi causes a life-threatening condition transmitted through the bite of the trombiculid mite. [1][2][3]14 The parasite invades the CNS by hematogenous spread and resides in vascular endothelium and circulating phagocytes. [1][2][3]14 The neuroinvasion results in host reaction and activates the cytokine and chemokine system, leading to parenchymal inflammation, perivasculitis, and infarction.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]14 The parasite invades the CNS by hematogenous spread and resides in vascular endothelium and circulating phagocytes. [1][2][3]14 The neuroinvasion results in host reaction and activates the cytokine and chemokine system, leading to parenchymal inflammation, perivasculitis, and infarction. [1][2][3]14 Acute inflammation of the endothelial cells causes platelet aggregation, leukocytic infiltration, cytokine release, and thrombotic microangiopathy.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]14 The neuroinvasion results in host reaction and activates the cytokine and chemokine system, leading to parenchymal inflammation, perivasculitis, and infarction. [1][2][3]14 Acute inflammation of the endothelial cells causes platelet aggregation, leukocytic infiltration, cytokine release, and thrombotic microangiopathy. [1][2][3]14 Clinical features, therefore, can result from direct damage to an area causing altered functioning or may be immune-mediated.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]14 Acute inflammation of the endothelial cells causes platelet aggregation, leukocytic infiltration, cytokine release, and thrombotic microangiopathy. [1][2][3]14 Clinical features, therefore, can result from direct damage to an area causing altered functioning or may be immune-mediated. [1][2][3]14 Severe scrub typhus is associated with interstitial pneumonia, renal failure, gastrointestinal bleeding, and CNS manifestations like meningoencephalitis (most common), cerebral infarction, transverse myelitis, movement disorders, and cranial neuropathy.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]14 Clinical features, therefore, can result from direct damage to an area causing altered functioning or may be immune-mediated. [1][2][3]14 Severe scrub typhus is associated with interstitial pneumonia, renal failure, gastrointestinal bleeding, and CNS manifestations like meningoencephalitis (most common), cerebral infarction, transverse myelitis, movement disorders, and cranial neuropathy. [1][2][3][4][5]14 Regardless, CVT is a rare manifestation.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Infection: A Case Report and a Review of the Literature

Biswas

Ghosh

Chakraborty

et al. 2022

MRAJ

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Neurological manifestations of scrub typhus, a re-emerging infectious disease of tropic/subtropics caused by Orientia tsutsugamushi infection, have been ever-evolving. Several central nervous system infections have been acknowledged for the development of cerebral venous sinus thrombosis (CVT). Nevertheless, CVT has been a rarely described addendum to the ever-evolving “neuro-scrub” spectrum. Proposed pathogenesis for the development of CVT is disseminated endotheliitis resulting in the triad of venous stasis (due to raised intracranial pressure), cerebral vasculopathy (endothelial damage), and capillary perivasculitis (endothelial damage and resultant hypercoagulable state generated by inflammatory mediators). We herein report a case of a previously healthy young female from the Indian subcontinent who was diagnosed with CVT, following scrub typhus. She responded well to conventional therapy with antibiotics and anticoagulants. CVT is amid the few completely reversible neurological catastrophes if diagnosed and treated early. Again, scrub typhus infection is treated with commonly available and extremely "affordable" antibiotics therapy. Hence, the authors propose that all cases of acute febrile illness with neurological manifestations from scrub-typhus endemic zones (like several parts of India) should be tested for the presence of Orientia tsutsugamushi infection and treated accordingly.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Infection: A Case Report and a Review of the Literature

Biswas

Ghosh

Chakraborty

et al. 2022

MRAJ

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Challenging neurological presentation: Scrub typhus with meningoencephalitis and multiple cranial nerve involvement

Biswas,

León‐Ruiz,

Shaikh

et al. 2024

Neurology & Clinical Neurosc

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A 40‐year‐old male farmer from rural West Bengal, India, presented with fever, headaches, seizure, eschar, and palsy of left cranial nerves VII, VIII, IX, and X as a rare clinical manifestation of scrub typhus. Positive IgM enzyme‐linked immunosorbent assay tests in serum and cerebrospinal fluid confirmed the diagnosis, with brain magnetic resonance imaging showing meningoencephalitis findings. Treatment with steroids and doxycycline led to neurological improvement. This case highlights the need for heightened clinician awareness toward early detection of scrub typhus's atypical presentations to ensure timely and effective treatment.

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A Novel Adult Case of Recurrent Acute Pancreatitis Caused by Hypercalcemia With Concurrent Manifestation of Posterior Reversible Encephalopathy Syndrome Revealing Undiagnosed Primary Hyperparathyroidism due to an Underlying Parathyroid Adenoma

Ghosh,

León-Ruiz,

Bole

et al. 2023

The Neurohospitalist

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Background Hypercalcemia-induced posterior reversible encephalopathy syndrome (PRES) is a rare entity primarily associated with iatrogenic vitamin D/calcium overdose, malignancy, or, infrequently, primary hyperparathyroidism. Case Report We present a novel case of an adult male from rural India who experienced recurrent acute pancreatitis caused by hypercalcemia with concurrent manifestation of PRES. Diagnostic evaluation revealed markedly elevated serum calcium levels and parathyroid hormone concentrations, consistent with primary hyperparathyroidism. Imaging studies identified a parathyroid adenoma near the right thyroid lobe, subsequently surgically excised. Discussion This case underscores the importance of considering primary hyperparathyroidism as an underlying cause of PRES, especially in the absence of acute arterial hypertension or autonomic dysfunction. Early recognition and intervention are essential in mitigating the morbidity and mortality of PRES.

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Rare neurological and neuropsychiatric manifestations of scrub typhus: a case series of 10 cases

Cited by 5 publications

References 57 publications

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Infection: A Case Report and a Review of the Literature

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Infection: A Case Report and a Review of the Literature

Challenging neurological presentation: Scrub typhus with meningoencephalitis and multiple cranial nerve involvement

A Novel Adult Case of Recurrent Acute Pancreatitis Caused by Hypercalcemia With Concurrent Manifestation of Posterior Reversible Encephalopathy Syndrome Revealing Undiagnosed Primary Hyperparathyroidism due to an Underlying Parathyroid Adenoma

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