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Rickettsial meningitis and encephalitis
K Silpapojakul1, C Ukkachoke, S Krisanapan
1Department of Medicine, Faculty of Medicine, Prince of Songkla University, Thailand.
Abstract:
Nine of 72 patients with scrub typhus and three of 137 with murine typhus presented with meningitis and/or encephalitis syndromes. Focal neurologic signs were rare, and cerebrospinal fluid profiles were similar to those of leptospirosis and viral and tuberculous meningitis. One patient had papilledema, and another had cerebellitis. Other major organ involvement (renal, liver, or lungs) occurred in five patients. One patient died and four spontaneously recovered, while the conditions of the rest responded well to either chloramphenicol or doxycycline. Scrub and murine typhus should be included in the differential diagnoses of aseptic meningitis and encephalitis in patients exposed to endemic areas, especially when accompanied by renal insufficiency and/or jaundice. They are treatable forms of virallike meningoencephalitis.
Insights
Scrub typhus and murine typhus can cause meningitis and encephalitis, mimicking viral infections. Early diagnosis and treatment with antibiotics like doxycycline are crucial for recovery.
Area of Science:
- Infectious Diseases
- Neurology
- Internal Medicine
Background:
- Scrub typhus and murine typhus are important causes of febrile illness in endemic areas.
- Neurological complications of typhus are not well-characterized.
- Differentiating typhus from other causes of meningoencephalitis is clinically significant.
Observation:
- Nine of 72 scrub typhus patients and 3 of 137 murine typhus patients presented with meningitis/encephalitis.
- Neurologic signs were infrequent; CSF profiles resembled other infectious meningitis types.
- Associated organ involvement (renal, liver, lung) occurred in 5 patients.
Findings:
- One patient expired, four recovered spontaneously, and others responded to chloramphenicol or doxycycline.
- Scrub and murine typhus are treatable causes of viral-like meningoencephalitis.
- Cerebellitis and papilledema were noted in individual cases.
Implications:
- Typhus should be considered in the differential diagnosis of aseptic meningitis/encephalitis in endemic areas.
- Co-occurring renal insufficiency or jaundice may suggest typhus.
- Prompt antibiotic treatment can lead to favorable outcomes in typhus-induced neurological syndromes.