title: Acute encephalitis syndrome following scrub typhus infection.
abstract: OBJECTIVE
  The aim was to find the incidence of acute encephalitis syndrome (AES) secondary to scrub infection and to observe the clinical, biochemical, radiological profile, and outcomes in these patients.
  
  
  METHODS
  A total of 20 consecutive patients of AES were evaluated for scrub infection using scrub typhus immunoglobulin M enzyme linked immuno-sorbant assay positivity along with the presence or absence of an eschar. Clinical profile, routine laboratory tests, cerebrospinal fluid (CSF) analysis, and neuroimaging were analyzed. Patients were treated with doxycycline and followed-up.
  
  
  RESULTS
  Among 20 consecutive patients with AES, 6 (30%) were due to scrub infection. They presented with acute onset fever, altered sensorium, seizures. Eschar was seen in 50% of patients. CSF done in two of them was similar to consistent with viral meningitis. Magnetic resonance imaging brain revealed cerebral edema, bright lesions in the putamen and the thalamus on T2-weighted and fluid-attenuated inversion recovery sequences. Renal involvement was seen in all patients. All patients responded well to oral doxycycline.
  
  
  CONCLUSIONS
  AES is not an uncommon neurological presentation following scrub typhus infection. It should be suspected in all patients with fever, altered sensorium, and renal involvement. Oral doxycycline should be started as early as possible for better outcomes.
authors.affiliation: Department of General Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Ayan
authors.initials: A
authors.lastname: Kar
authors.affiliation: Institute of Neurosciences, Apollo Main Hospitals, Chennai, Tamil Nadu, India.
authors.forename: M
authors.initials: M
authors.lastname: Dhanaraj
authors.affiliation: Institute of Critical Care Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Devaprasad
authors.initials: D
authors.lastname: Dedeepiya
authors.affiliation: Department of General Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India.
authors.forename: K
authors.initials: K
authors.lastname: Harikrishna
keywords: Acute encephalitis syndrome; multidisciplinary care; renal involvement; scrub typhus
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