title: CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India.
abstract: OBJECTIVE
  To present the clinical, lab profile and outcome of a series of six children who had features of meningoencephalitis (median age of 10.5 y) diagnosed as confirmed scrub typhus (ST) by using a lgM ELISA commercial kit (InBiOS International Inc. USA).
  
  
  METHODS
  This was a prospective observational study conducted at a tertiary care hospital, over a period of 7 mo through April 2014. All the patients with undifferentiated febrile illness (aged 1-18 y) with fever of 5-21 d duration were evaluated. After thorough physical examination they were subjected to blood investigations such as complete blood count (CBC), blood culture, hepatic and kidney function tests, serum electrolytes, cerebrospinal fluid (CSF) analysis and IgM ELISA for scrub typhus, coagulogram and chest radiograph, wherever indicated.
  
  
  RESULTS
  During this period, of the total 81 confirmed cases based on a positive scrub IgM ELISA and/or eschar, 6 (7.4 %), had neurological involvement in the form of presence of neck stiffness, altered sensorium and/or seizures and the CSF findings were suggestive of meningoencephalitis and all had evidence of multiple organ dysfunction syndrome (MODS) needing intensive care. The CECT could be performed in four patients only showing evidence of effacement of sulci and evidence of brain edema.
  
  
  CONCLUSIONS
  This communication highlights that variable central nervous system (CNS) involvement is not uncommon in patients with scrub typhus with high mortality. CSF and neuro-radiology findings are nonspecific as these are also observed in patients with aseptic meningitis or encephalitis. Early suspection and institution of appropriate therapy without delay will lead to substantial reduction in the morbidity and mortality.
authors.affiliation: Department of Pediatric & Adolescent Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, 171001, India. doc.aksood@gmail.com.
authors.forename: Ashwani Kumar
authors.initials: AK
authors.lastname: Sood
authors.affiliation: Department of Pediatric & Adolescent Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, 171001, India.
authors.forename: Lokesh
authors.initials: L
authors.lastname: Chauhan
authors.affiliation: Department of Pediatric & Adolescent Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, 171001, India.
authors.forename: Hemant
authors.initials: H
authors.lastname: Gupta
mesh_terms: D002493:Central Nervous System Diseases / Q000209:etiology*; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D012285:Orientia tsutsugamushi / Q000472:pathogenicity; D011446:Prospective Studies; D012612:Scrub Typhus / Q000150:complications* / Q000175:diagnosis
keywords: Children; Meningoencephalitis; Rickettsia
references.citation: Diagn Microbiol Infect Dis. 2008 Feb;60(2):237-9
references.pmid: 17997258
references.citation: Clin Neurol Neurosurg. 2011 Apr;113(3):250-3
references.pmid: 21129847
references.citation: Ann Indian Acad Neurol. 2012 Apr;15(2):141-4
references.pmid: 22566732
references.citation: PLoS One. 2013 Jun 14;8(6):e66595
references.pmid: 23799119
references.citation: Diagn Microbiol Infect Dis. 2011 Mar;69(3):271-4
references.pmid: 21353950
references.citation: Clin Infect Dis. 1997 Mar;24(3):436-40
references.pmid: 9114196
references.citation: Antimicrob Agents Chemother. 1998 Oct;42(10):2626-9
references.pmid: 9756766
references.citation: J Assoc Physicians India. 2010 Jan;58:24-8
references.pmid: 20649095
references.citation: Antimicrob Agents Chemother. 1991 Dec;35(12):2457-62
references.pmid: 1810178
references.citation: Curr Opin Infect Dis. 2003 Oct;16(5):429-36
references.pmid: 14501995
references.citation: Am J Pathol. 1945 Jul;21(4):603-81
references.pmid: 19970829
references.citation: Int J Infect Dis. 2014 Jun;23:39-43
references.pmid: 24661931
references.citation: Arch Intern Med. 1991 Sep;151(9):1753-7
references.pmid: 1888241
references.citation: Am J Trop Med Hyg. 2010 Mar;82(3):368-70
references.pmid: 20207857
references.citation: Arch Neurol. 2000 Dec;57(12):1770-2
references.pmid: 11115244
references.citation: Antimicrob Agents Chemother. 1985 Aug;28(2):347-8
references.pmid: 3834836
references.citation: Trop Doct. 2010 Jul;40(3):129-33
references.pmid: 20360426
references.citation: Clin Infect Dis. 2004 Nov 1;39(9):1395-6
references.pmid: 15494919
references.citation: J Infect. 2006 Jan;52(1):56-60
references.pmid: 16368461
references.citation: Antimicrob Agents Chemother. 1989 Jul;33(7):1078-80
references.pmid: 2782858
references.citation: Southeast Asian J Trop Med Public Health. 2002 Sep;33(3):557-64
references.pmid: 12693591
references.citation: Radiographics. 2007 Jan-Feb;27(1):161-72
references.pmid: 17235005
references.citation: J Laryngol Otol. 2011 Jun;125(6):567-71
references.pmid: 21371369
references.citation: Antimicrob Agents Chemother. 1996 Mar;40(3):825-6
references.pmid: 8851625
references.citation: BMC Infect Dis. 2010 Apr 30;10:108
references.pmid: 20433689
references.citation: Indian J Crit Care Med. 2014 Jul;18(7):453-5
references.pmid: 25097358
references.citation: Kaohsiung J Med Sci. 2011 Dec;27(12):573-6
references.pmid: 22208541
references.citation: Arch Neurol Psychiatry. 1949 May;61(5):545-57
references.pmid: 18129174
references.citation: Ir J Med Sci. 2009 Sep;178(3):347-50
references.pmid: 19009332
references.citation: Int J Infect Dis. 2012 Jul;16(7):e514-7
references.pmid: 22541336
references.citation: Clin Microbiol Rev. 2004 Apr;17(2):323-47
references.pmid: 15084504
references.citation: Neurol India. 2013 Jan-Feb;61(1):17-20
references.pmid: 23466834
references.citation: PLoS Negl Trop Dis. 2014 Jan 30;8(1):e2605
references.pmid: 24498445
references.citation: Am J Trop Med Hyg. 2009 Sep;81(3):484-8
references.pmid: 19706919
references.citation: Antimicrob Agents Chemother. 2014;58(3):1488-93
references.pmid: 24366734
references.citation: PLoS Negl Trop Dis. 2012;6(8):e1789
references.pmid: 22905277
references.citation: Trop Doct. 2014 Jan;44(1):36-7
references.pmid: 24226290
references.citation: Am Heart J. 1946 Mar;31:314-28
references.pmid: 21018737