CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India

Area of Science:

• Pediatric Infectious Diseases
• Neurology
• Microbiology

Background:

• Scrub typhus (ST) is a significant cause of febrile illness in endemic areas.
• Neurological involvement in ST, though reported, requires further characterization in pediatric populations.
• Meningoencephalitis presents a diagnostic challenge due to non-specific clinical and laboratory findings.

Purpose of the Study:

• To detail the clinical presentation, laboratory findings, and outcomes of children diagnosed with scrub typhus-induced meningoencephalitis.
• To highlight the diagnostic utility of IgM ELISA for scrub typhus in pediatric cases with neurological symptoms.
• To emphasize the importance of early recognition and management of scrub typhus in children presenting with central nervous system involvement.

Main Methods:

• Prospective observational study of pediatric patients (1-18 years) with undifferentiated febrile illness.
• Inclusion criteria: fever duration of 5-21 days, evaluation with physical examination and blood investigations.
• Diagnostic methods included IgM ELISA for scrub typhus, CSF analysis, and neuroimaging (CECT) where indicated.

Main Results:

• Six out of 81 confirmed scrub typhus cases (7.4%) presented with meningoencephalitis, characterized by neck stiffness, altered sensorium, and/or seizures.
• All affected children exhibited evidence of multiple organ dysfunction syndrome (MODS) requiring intensive care.
• Cerebrospinal fluid (CSF) and CECT findings were non-specific, showing effacement of sulci and brain edema.

Conclusions:

• Central nervous system involvement, including meningoencephalitis, is a significant and potentially fatal complication of scrub typhus in children.
• CSF and neuro-radiological findings in scrub typhus meningoencephalitis are often non-specific, mimicking other forms of meningitis or encephalitis.
• Prompt suspicion and initiation of appropriate antibiotic therapy are vital for improving outcomes and reducing mortality in pediatric scrub typhus.