Scrub Typhus Presenting as Unilateral Abducens Nerve Palsy

Ghosh, Ritwik; Biswas, Subhrajyoti; Mandal, Arnab; De, Kaustav; Bandyopadhyay, Srijit; Sardar, Sona Singh; Mandal, Arpan; Benito‐León, Julián

doi:10.1080/01658107.2021.1909073

Cited by 5 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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 The invasion by the pathogen damages endothelial integrity and cytokines released by these inflamed endothelial cells lead to fluid permeation, platelet and polymorph aggregation, and monocyte proliferation, further resulting in focal obliterative angiitis and microthrombi formation in the vicinity of the leptomeninges, brain parenchyma, and venous sinuses. [1][2][3][4][5][6] An eschar, which is often pathognomonic for scrub typhus infection found in intertriginous body portions as a bite mark of the vector (larval stage of trombiculid mite), is often absent and fails to provide an early clue to clinch the diagnosis. 7 Several central nervous system (CNS) infections can result in the development of cerebral venous sinus thrombosis (CVT).…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

Scrub typhus presenting as diaphragmatic myoclonus

et al. 2022

Self Cite

View full text Add to dashboard Cite

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Meningoencephalitis in a Pregnant Woman

Biswas,

León-Ruiz,

Ghosh

et al. 2024

The Neurohospitalist

View full text Add to dashboard Cite

Background Scrub typhus, a mite-borne zoonosis caused by Orientia tsutsugamushi, is prevalent in the Asia Pacific region and presents with various neurological manifestations, including meningoencephalitis, polyneuropathy, and, rarely, cerebral venous sinus thrombosis (CVST). Case Report We report a unique case of CVST following scrub typhus meningoencephalitis in an 18-year-old pregnant woman from West Bengal, India. Her condition was complicated by fever, headache, neck stiffness, and altered sensorium. Laboratory tests revealed leukopenia and thrombocytopenia, while serologies for other infectious diseases were negative. Cerebrospinal fluid analysis was significant for lymphocytic pleocytosis and elevated protein, with a positive O tsutsugamushi-IgM assay. Treatment with azithromycin resulted in initial improvement; however, persistent headaches led to the discovery of CVST. The patient responded well to anticoagulation therapy with low molecular weight heparin and was discharged asymptomatic, with subsequent uneventful pregnancy and delivery. Discussion Cerebral venous sinus thrombosis should be ruled out in pregnant women with refractory scrub typhus meningoencephalitis despite antibiotic therapy. Because scrub typhus is treatable with intravenous doxycycline and azithromycin, it should be considered in the workup of febrile patients with acute onset neurological disorders in the tropics or subtropics or travelers coming back from endemic areas, despite the absence of eschar and unremarkable neuroimaging findings.

show abstract

Scrub Typhus Presenting as Unilateral Abducens Nerve Palsy

Cited by 5 publications

References 12 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

Scrub typhus presenting as diaphragmatic myoclonus

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Meningoencephalitis in a Pregnant Woman

Contact Info

Product

Resources

About