title: Scrub typhus meningitis or meningoencephalitis.
abstract: Orientia tsutsugamushi induces vasculitis leading to symptoms of systemic organ invasion including meningitis and meningoencephalitis. We conducted a retrospective case-control study of scrub typhus patients to investigate the clinical and laboratory features of patients with scrub typhus meningitis or meningoencephalitis, and the therapeutic outcomes, and to determine the predictor factors. Cases were 22 patients with scrub typhus meningitis or meningoencephalitis, and controls were 303 patients without meningitis or meningoencephalitis. Multivariate analysis showed that the presence of pneumonitis was associated with the occurrence of scrub typhus meningitis and meningoencephalitis (odds ratio [OR] 8.9; P < 0.001; confidence interval [CI] 2.9-27.2). Although appropriate antimicrobials such as doxycycline agents were administered at an early stage, meningitis or meningoencephalitis still occurred in some cases. Physicians should be aware that meningitis or meningoencephalitis may develop during appropriate drug therapy such as doxycycline. Close observation and great care are essential for patients with risk factors, particularly pneumonitis.
authors.affiliation: Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea.
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Kim
authors.forename: Jong-Hoon
authors.initials: JH
authors.lastname: Chung
authors.forename: Na-Ra
authors.initials: NR
authors.lastname: Yun
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Mi Ah
authors.initials: MA
authors.lastname: Han
authors.forename: Yong-Bok
authors.initials: YB
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000188:drug therapy / Q000209:etiology*; D008590:Meningoencephalitis / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D012285:Orientia tsutsugamushi / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D011014:Pneumonia / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012612:Scrub Typhus / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline