Related Experiment Video
Updated: Sep 5, 2025
A Murine Model of Dengue Virus-induced Acute Viral Encephalitis-like Disease
Published on: April 28, 2019
Meningeal Signs and Cerebellar Involvement in Scrub Typhus: A Case Report
Sadikshya Bhandari1, Samikshya Bhandari2, Kushal Gautam3
1Internal Medicine, Dhulikhel Hospital, Dhulikhel, NPL.
Abstract:
Scrub typhus is an arthropod-borne fever that follows the bite of the larval form of Leptotrombidium mite carrying Orientia tsutsugamushi. It remains a serious health problem in the Asia-Pacific region. While it commonly presents as an undifferentiated fever with chills and an eschar, complications like pneumonitis, acute respiratory distress syndrome, disseminated intravascular coagulation, and meningoencephalitis may cause scrub typhus to be fatal. However, regardless of the dramatic presentation, treatment with antibiotics, preferably doxycycline or even azithromycin, is effective in recovery. In this case report, we present a case of meningitis and cerebellar involvement in an adolescent with positive scrub typhus serology in the absence of an eschar. This brought forward a diagnostic delay as other infections including tuberculosis were considered before scrub typhus due to unusual presenting symptoms and the lack of an eschar. Thus, in cases like these, it becomes imperative to be aware of the unusual manifestations to initiate antibiotics on time and prevent further complications.
Insights
Scrub typhus, an arthropod-borne illness, can cause severe complications. Early recognition of unusual symptoms, even without an eschar, is crucial for timely antibiotic treatment and improved patient outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Scrub typhus, caused by Orientia tsutsugamushi transmitted by Leptotrombidium mites, is a significant public health concern in the Asia-Pacific region.
- Typical symptoms include fever, chills, and an eschar, but severe complications like pneumonitis and meningoencephalitis can be fatal.
- Antibiotic treatment, particularly with doxycycline or azithromycin, is effective for recovery.
Observation:
- This case report details an adolescent presenting with meningitis and cerebellar involvement.
- The patient had positive scrub typhus serology but lacked the characteristic eschar.
- Diagnostic delay occurred due to consideration of other infections like tuberculosis.
Findings:
- The absence of an eschar and unusual neurological symptoms complicated the diagnosis of scrub typhus.
- Early identification of scrub typhus is critical, even with atypical presentations.
- Prompt antibiotic administration is key to preventing severe outcomes.
Implications:
- Highlights the importance of considering scrub typhus in differential diagnoses, especially in endemic areas, even with atypical symptoms.
- Emphasizes the need for increased awareness among clinicians regarding the diverse clinical manifestations of scrub typhus.
- Timely diagnosis and treatment of scrub typhus can prevent potentially fatal complications and improve patient prognosis.
