Comparison of Scrub Typhus With and Without Meningitis
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To compare the children admitted with scrub typhus with and without meningitis.
All children admitted with scrub typhus over a 62 mo period were reviewed. Statistical analysis was performed to compare those with and without meningitis for demographic, clinical, investigations and outcome parameters.
Four hundred twenty seven children were admitted with scrub typhus and 63 (14.8%) had meningitis. The mean cerebrospinal fluid white blood cell (CSF WBC) count was 71 cells/cu.mm. with mean lymphocyte proportion of 92%. The mean CSF protein was 67 mg/dl and mean CSF glucose, 55 mg/dl. Of those who had meningitis, 24 (38.1%) had seizures, 17 (27%) had altered sensorium and 37 (58.7%) had nuchal rigidity. Finding an eschar, being male, breathing difficulty, and hepatomegaly were significantly more common in those without meningitis. Children with meningitis also had shorter duration of fever at presentation (median [IQR] 7  days vs. 10  days; p = 0.028). Headache and vomiting were significantly more common in those with meningitis. Hemoglobin and platelet were significantly lower in those without meningitis. Duration of hospitalization was significantly longer in those with meningitis, whereas acute respiratory distress syndrome (ARDS) was significantly more common in those without meningitis. There was no neurological deficit in both the groups. There was no mortality in the meningitis group compared to 3.6% mortality in the non-meningitis group (p = 0.213).
Meningitis occurs in 15% of those with scrub typhus; those with meningitis have good neurological outcome with little mortality; those without meningitis have more complications and poorer outcome.
KeywordsScrub typhus Meningitis Children Cerebrospinal fluid (CSF)
The authors would like to acknowledge Mr. E. Prabhu who helped with data collection and data entry.
WR: Conception and design of the study, data interpretation and preparation of the manuscript; UG, AP, VPV, JJAP: Data interpretation, preparation of manuscript; RS: Data analysis and preparation of manuscript; All authors approved the final manuscript. WR will act as guarantor for the paper.
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- 1.Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003;16:429–36.Google Scholar
- 5.Ahmad S, Srivastava S, Verma SK, Puri P, Shirazi N. Scrub typhus in Uttarakhand, India: a common rickettsial disease in an uncommon geographical region. Trop Doct. 2010;40:188–90.Google Scholar
- 7.Taylor AJ, Paris DH, Newton PN. A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis. 2015;9:e0003971.Google Scholar
- 9.Ting KS, Lin JC, Chang MK. Brachial plexus neuropathy associated with scrub typhus: report of a case. J Formos Med Assoc. 1992;91:110–2.Google Scholar
- 10.Lee S-H, Jung S-I, Park K-H, et al. Guillain-Barré syndrome associated with scrub typhus. Scand J Infect Dis. 2007;39:826–8.Google Scholar
- 14.Chen P-H, Hung K-H, Cheng S-J, Hsu K-N. Scrub typhus-associated acute disseminated encephalomyelitis. Acta Neurol Taiwan. 2006;15:251–4.Google Scholar
- 16.Pai H, Sohn S, Seong Y, Kee S, Chang WH, Choe KW. Central nervous system involvement in patients with scrub typhus. Clin Infect Dis. 1997;24:436–40.Google Scholar
- 19.Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in south India — a retrospective study. PLoS ONE [Internet]. 2013. Available at:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682970/. Accessed on 3rd November 2016.
- 24.Isaac R, Varghese GM, Mathai E, Manjula J, Joseph I. Scrub typhus: prevalence and diagnostic issues in rural southern India. Clin Infect Dis. 2004;39:1395–6.Google Scholar