Scrub typhus meningo-encephalitis with focal neurologic signs and associated brain MRI abnormal findings: Literature review

Yum, Kyu Sun; Na, Sang-Jun; Lee, Kee Ook; Ko, Jung Ho

doi:10.1016/j.clineuro.2010.11.007

Cited by 25 publications

(25 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Foci of vasculitis in the brain, lymphocytic infiltration of blood vessels and perivascular space are seen in scrub typhus. On MRI, white matter T2 hyper intensity in the subcortical region, cerebellum and brainstem have been reported in scrub typhus22 and these changes are suggestive of ischaemic changes due to vasculitis or para-infectious demyelination. The exact timing of MRI study after fever has not been clearly mentioned in some of these reports.…”

Section: Discussionmentioning

confidence: 97%

Neurological manifestations of scrub typhus

Misra

Mani

2014

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 97%

Neurological manifestations of scrub typhus

Misra

Mani

2014

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

show abstract

“…Prospective studies with cryptococcal antigen testing and PCR based kits like Xpert MTB/RIF (which were not performed in our patients due to unavailability) is needed in scrub meningitis to rule out other differential diagnoses. Scrub typhus meningitis can also be differentiated from TBM by the shorter period taken towards normalization [46]. Rifampicin is also used to treat severe scrub typhus and presence of lymphocytic CSF in a given patient, with improvement following antituberculous therapy (ATT) may mask the diagnosis of scrub typhus.…”

Section: Discussionmentioning

confidence: 99%

Scrub Typhus Meningitis in South India — A Retrospective Study

et al. 2013

View full text Add to dashboard Cite

BackgroundScrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reportsMethodsA retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness- a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits.ResultsSixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol.ConclusionMeningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.

show abstract

“…Thus, scrub typhus rarely involves the white matter, and only a few reports have described cases of scrub typhus involving the white matter (3,7). According to a previous case report, the white matter can be destroyed because of a blood-brain barrier breakdown, microinfarction, and edema (7).…”

Section: Discussionmentioning

confidence: 99%

“…Scrub typhus is usually limited to the gray matter because, pathologically, it involves small vessels throughout the body (7,9). Thus, scrub typhus rarely involves the white matter, and only a few reports have described cases of scrub typhus involving the white matter (3,7).…”

Section: Discussionmentioning

confidence: 99%