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MRI Brain Findings and Clinical Spectrum of Children With Typhus-Positive Acute Encephalitis Syndrome: Associations

Anita Mehta1, Saeed Gani2, Vijai Shankar3

  • 1Pediatrics, Baba Raghav Das Medical College, Gorakhpur, Gorakhpur, IND.

Cureus
|March 30, 2026
PubMed

Insights

Scrub typhus is the primary cause of acute encephalitis syndrome (AES) in North Indian children. This study found MRI abnormalities in scrub typhus patients are linked to complications and long-term effects.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Neurology

Background:

  • Scrub typhus, caused by Orientia tsutsugamushi transmitted by chiggers, is a major cause of acute encephalitis syndrome (AES) in children in Southeast Asia.
  • This study focuses on the prevalence and neurological impact of scrub typhus in pediatric AES cases in North India.

Purpose of the Study:

  • To determine the prevalence of scrub typhus among children with AES in Gorakhpur, India.
  • To investigate the association between scrub typhus infection and MRI findings, clinical complications, and sequelae in pediatric AES patients.

Main Methods:

  • A cross-sectional study was conducted in a tertiary care hospital's pediatric intensive care unit (PICU) from October 2021 to September 2022.
  • 274 AES patients were screened for scrub typhus using enzyme-linked immunosorbent assay (ELISA).
  • MRI findings, clinical data, and patient outcomes were analyzed.

Main Results:

  • 144 out of 274 (52.55%) AES patients tested positive for scrub typhus.
  • The majority of affected children (50%) were between 1-5 years old.
  • MRI abnormalities were observed in 27.10% of scrub typhus patients, with lesions in various brain regions.
  • Significant associations were found between scrub typhus and shock, myocarditis, refractory seizures, respiratory failure, and sequelae.

Conclusions:

  • Scrub typhus is identified as the leading cause of AES in North India.
  • Abnormal MRI findings in scrub typhus-associated AES are significantly linked to complications and long-term sequelae.

Keywords:
acute encephalitis syndrome (aes)magnetic resonance imaging (mri)myocarditisorientia tsutsugamushipediatric intensive care unit (picu)refractory seizurescrub typhussequelae

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