Status epilepticus in scrub typhus versus tuberculous meningitis: A comparative study

Scrub typhus (ST) and tuberculous meningitis (TBM) are common infections in tropical regions and can present with various neurological manifestations, including seizures and status epilepticus (SE). This study compared the demographic profiles, clinical features, treatment responses, and outcomes of SE in patients with TBM and ST, using data from our patient cohort and existing literature.

Patients with TBM or ST presenting with SE were identified from ongoing prospective registries. Detailed demographic, clinical, laboratory, EEG, and MRI findings, along with treatment response and outcomes, were recorded and compared between the groups.

Twenty-eight out of 587 meningitis patient had SE; 17 had TBM and 11 ST. ST patients had lower hemoglobin (p = 0.005), lower platelet counts (p < 0.001), and higher serum creatinine (p = 0.01), bilirubin (p = 0.01), and ALT (p = 0.02) than TBM-SE patients. MRI was abnormal in all TBM-SE patients, but normal in ST-SE. TBM patients had delayed SE (88.2 %), whereas all the ST patients had early onset SE (p < 0.001). TBM-SE required 3 or more antiseizure medications (ASM) and had often refractory (58.8 % vs. 27.3 %) and super-refractory SE (17.6 % vs. 0 %). Mortality was higher in TBM-SE (47.1 %), whereas all ST-SE patients recovered. Only 33 % TBM survivors had good recovery at 6 months. None of the ST patients had recurrence or breakthrough seizure after withdrawal of ASM.

SE in TBM is more refractory and associated with higher mortality and disability than in ST. ASM may be safely withdrawn early in ST-SE, whereas TBM-SE requires prolonged treatment.