title: Scrub typhus meningoencephalitis, a diagnostic challenge for clinicians: A hospital based study from North-East India.
abstract: Central nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis.
  
  
  OBJECTIVE
  To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis.
  
  
  METHODS
  This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test).
  
  
  RESULTS
  13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 %) patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%), 13 (100%), 6 (46.15%) and 10 (76.92%) patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively. Mean total count of CSF leukocyte and lymphocyte percentage was 46.07±131 cell/cumm and 98.66±3.09% respectively. Tablet doxycycline with or without injection azithromycin was used and that shows good response 15.38% of patients died and all of them had multi organ dysfunction.
  
  
  CONCLUSIONS
  Meningoencephalitis is a common manifestation of scrub typhus and diagnosis requires high degree of clinical suspicion which if diagnosed early and specific treatment started, patients usually recover completely with few complications.
authors.affiliation: Department of Medicine, NEIGRIHMS, Shillong, Meghalaya, India.
authors.forename: M D
authors.initials: MD
authors.lastname: Jamil
authors.affiliation: Department of Neurology, NEIGRIHMS, Shillong, Meghalaya, India.
authors.forename: Masaraf
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Department of Medicine, NEIGRIHMS, Shillong, Meghalaya, India.
authors.forename: Monaliza
authors.initials: M
authors.lastname: Lyngdoh
authors.affiliation: Department of Neurology, NEIGRIHMS, Shillong, Meghalaya, India.
authors.forename: Shriram
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Medicine, NEIGRIHMS, Shillong, Meghalaya, India.
authors.forename: Bhupen
authors.initials: B
authors.lastname: Barman
authors.affiliation: Department of Medicine, NEIGRIHMS, Shillong, Meghalaya, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Bhattacharya
keywords: Cerebrospinal fluid; meningoencephalitis; scrub typhus