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Central nervous system involvement in patients with scrub typhus
1Division of Infectious Diseases, College of Medicine, University of Dankook, Cheonan, Korea.
Summary
Scrub typhus, caused by Orientia tsutsugamushi, can invade the central nervous system. This study found evidence of Orientia tsutsugamushi DNA in cerebrospinal fluid, suggesting scrub typhus as a cause of infectious meningitis.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Scrub typhus, caused by Orientia tsutsugamushi, is a systemic vasculitis.
- Central nervous system (CNS) involvement is common in rickettsial diseases, but direct evidence in scrub typhus is often lacking.
- Previous reports suggest meningitis or encephalitis in scrub typhus without confirmed CNS invasion.
Purpose of the Study:
- To investigate CNS involvement in scrub typhus patients.
- To analyze cerebrospinal fluid (CSF) profiles and detect rickettsial DNA in CSF.
- To determine if Orientia tsutsugamushi invades the CNS during scrub typhus infection.
Main Methods:
- Analysis of CSF cell counts, protein, and glucose levels in 25 scrub typhus patients.
- Nested polymerase chain reaction (PCR) to amplify rickettsial DNA in CSF specimens.
- Genotyping of amplified rickettsial DNA.
Main Results:
- 48% of patients showed mild pleocytosis (mean WBC 16.3/mm3, 51.9% lymphocytes).
- Elevated CSF protein levels (>50 mg/dL) were observed in seven patients.
- Nested PCR detected Orientia tsutsugamushi DNA in six of 25 CSF samples (four Boryong, two Karp genotypes).
Conclusions:
- Orientia tsutsugamushi can invade the cerebrospinal fluid.
- Scrub typhus should be considered a cause of mononuclear meningitis in endemic areas.
- These findings provide direct evidence of CNS invasion in scrub typhus.