Challenging Neurological Presentation: Scrub Typhus with Meningoencephalitis and Multiple Cranial Nerve Involvement

Area of Science:

• Infectious Diseases
• Neurology
• Tropical Medicine

Background:

• Scrub typhus, caused by Orientia tsutsugamushi, is a significant public health concern in Asia.
• Neurological complications of scrub typhus are well-documented but rare presentations require further investigation.

Purpose of the Study:

• To report a rare case of scrub typhus presenting with multiple cranial nerve palsies and meningoencephalitis.
• To emphasize the importance of considering scrub typhus in the differential diagnosis of febrile illnesses with neurological manifestations.

Main Methods:

• Case presentation of a 40-year-old male farmer with specific symptoms.
• Diagnostic confirmation using IgM enzyme-linked immunosorbent assay (ELISA) in serum and cerebrospinal fluid (CSF).
• Brain magnetic resonance imaging (MRI) to evaluate neurological involvement.

Main Results:

• The patient presented with fever, headache, seizure, eschar, and palsies of left cranial nerves VII, VIII, IX, and X.
• IgM ELISA tests were positive in both serum and CSF, confirming scrub typhus.
• Brain MRI revealed findings consistent with meningoencephalitis.

Conclusions:

• Scrub typhus can manifest with rare and severe neurological complications, including cranial nerve palsies.
• Prompt diagnosis and treatment with doxycycline and steroids are crucial for favorable outcomes.
• Clinician awareness of atypical scrub typhus presentations is vital for timely intervention.