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Scrub typhus meningitis: An under-recognized cause of aseptic meningitis in India

Kundavaram Paul Prabhakar Abhilash1, Karthik Gunasekaran, Shubhanker Mitra

  • 1Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.

Neurology India
|May 8, 2015
PubMed
Abstract

Insights

Scrub typhus can cause meningitis and meningo-encephalitis, with CSF showing lymphocytic pleocytosis. Eschar presence and altered sensorium predict mortality in these CNS infections.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Public Health

Background:

  • Central nervous system (CNS) involvement occurs in up to 25% of scrub typhus cases.
  • Literature on cerebrospinal fluid (CSF) analysis and outcomes in scrub typhus meningitis/meningo-encephalitis is limited.

Purpose of the Study:

  • To analyze the clinical and laboratory features of scrub typhus meningitis/meningo-encephalitis.
  • To investigate CSF findings and patient outcomes in scrub typhus CNS infections.
  • To identify predictors of mortality in scrub typhus meningitis/meningo-encephalitis.

Main Methods:

  • Retrospective study of 189 patients with scrub typhus meningitis/meningo-encephalitis (2005-2011).
  • Documentation of clinical presentation, laboratory results, CSF analysis, and patient outcomes.
  • Univariate analysis to identify mortality predictors.

Main Results:

  • Common symptoms included headache, nausea/vomiting, altered sensorium, and seizures.
  • CSF analysis revealed modest cell elevation with lymphocytic predominance (mean 80 cells/cu mm, 87.6% lymphocytes).
  • Mortality rate was 5.8%; eschar presence and altered sensorium were significant predictors of death.

Conclusions:

  • Scrub typhus should be considered in the differential diagnosis of aseptic meningitis in endemic areas.
  • CSF findings of lymphocytic pleocytosis and multi-organ involvement suggest scrub typhus meningitis/meningo-encephalitis.
  • Early recognition and management are crucial for improving outcomes.

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