Neurological Manifestations of Scrub Typhus: The Clinical Spectrum, Determinants, and Outcome

Neurological involvement is reported in up to a quarter of patients with scrub typhus. However, prospective studies accurately describing clinical findings, temporal evolution, and rare syndromes are sparse. This study characterized scrub typhus-associated neurological syndromes, emphasizing neurological localization, clinical outcomes, and potential predictors.

This prospective cohort study included patients admitted to a medical college hospital with scrub typhus during a 1-year period. Detailed clinical, laboratory, and radiological profiles and outcomes were documented and analyzed.

Among 198 patients included, whose median age was 47 years (range, 18-85 years), 48.5% were men. The mean duration of fever before presentation was 8.2 days. Neurological deficits attributable to scrub typhus were present in 31.3% of patients. The commonest syndrome was meningitis/meningoencephalitis (87.9%). Extrapyramidal disorders occurred in 10%, and cerebellar disorders occurred in 3%. Extrapyramidal disorders often developed during the acute stage and persisted into early convalescence. Ischemic stroke and new-onset peripheral neuropathies occurred in two and three patients, respectively. Parameters in patients with and without neurological manifestations were compared. Multivariate analysis revealed that male sex, headache, vomiting, and elevated creatinine increased the odds of neurological involvement. Myalgia and tachycardia reduced the odds of neurological disease. Overall mortality was 6.1%. Neurological involvement was not associated with poor outcomes.

Neurological involvement was present in nearly one-third of patients with scrub typhus, with meningoencephalitis being the most common manifestation. Headache, vomiting, and elevated creatinine predicted neurological involvement, while myalgia and tachycardia were negatively associated.