title: Scrub Typhus: A Clinico-Laboratory Differentiation of Children with and without Meningitis.
abstract: Neurological involvement in the form of meningitis or meningoencephalitis, although well documented in scrub typhus, has not been extensively studied in the pediatric population. We report the clinical and laboratory profile of 96 children with scrub typhus and compared those with and without meningitis. Twenty seven (28%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), meningeal signs (66.6%), nausea and vomiting (56.3%), seizures (55.5%) and altered sensorium (51.8%). The children with meningitis presented early and had significantly lower respiratory and renal impairments when compared with the non-meningitis group. Cerebrospinal fluid (CSF) analysis revealed elevated total leukocyte count (86.73 ± 94.50 cells/mm(3)), mononuclear pleocytosis (lymphocyte percentage of 76.85 ± 15.86), elevated proteins (108.33 ± 52.63 mg%) and normal CSF glucose (64.18 ± 15.92 mg%). We conclude that meningitis is a common and early complication of childhood scrub typhus. The CSF reveals a lymphocytic pleocytosis, raised proteins and a normal glucose level. These children respond promptly to appropriate antibiotics as do children without meningitis.
authors: Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India drnmbhat@gmail.com.
authors: Nowneet Kumar
authors: NK
authors: Bhat
authors: Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Neerul
authors: N
authors: Pandita
authors: Department of Radio Diagnosis, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Manju
authors: M
authors: Saini
authors: Department of Medicine, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Minakshi
authors: M
authors: Dhar
authors: Department of Medicine, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Sohaib
authors: S
authors: Ahmed
authors: Department of Pathology, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Nadia
authors: N
authors: Shirazi
authors: Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Sanober
authors: S
authors: Wasim
authors: Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Rupali
authors: R
authors: Shirke
authors: Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India.
authors: Vipan
authors: V
authors: Chandar
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000378:metabolism*; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005334:Fever / Q000209:etiology; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007194:India; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D012285:Orientia tsutsugamushi / Q000302:isolation & purification; D011446:Prospective Studies; D012612:Scrub Typhus / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis*
chemical_list: D000900:Anti-Bacterial Agents; D002556:Cerebrospinal Fluid Proteins; D007075:Immunoglobulin M; D005947:Glucose
keywords: children; eschar; meningitis; rickettsia; scrub typhus