title: Neurological manifestations of scrub typhus in adults.
abstract: In order to study the neurological manifestations in adult patients suffering from scrub typhus, 323 patients aged over 18 years, admitted with a positive diagnosis, were screened for neurological dysfunction; 37 patients with symptoms and/or signs suggestive of neurological dysfunction were included in the study. Of these, 31 (84%) patients had altered sensorium, four (11%) had cerebellitis, one (2%) patient had acute transverse myelitis and one (2%) had bilateral papilloedema without focal neurological deficit. Of the 31 patients with altered sensorium, 15 (40%) had meningoencephalitis, three (8%) had seizures, two (5%) had cerebral haemorrhages, one (2%) had a presentation likened to neuroleptic malignant syndrome (NMS) and one (2%) had a 6th nerve palsy with inflammation of the right cavernous sinus. Cerebrospinal fluid (CSF) analysis was abnormal in 23 patients (raised lymphocytes in 68%, raised protein in 80%). All patients improved with anti-rickettsial therapy.
authors.affiliation: Resident, I.G. Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Rana
authors.affiliation: Associate Professor, I.G. Medical College, Shimla, Himachal Pradesh, India sanjay_mahajan64@rediff.com.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Mahajan
authors.affiliation: Resident, I.G. Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Arindam
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Neurology, I.G. Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Professor, I.G. Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Balbir S
authors.initials: BS
authors.lastname: Verma
authors.affiliation: Professor and Head Department of Medicine, I.G. Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012285:Orientia tsutsugamushi / Q000276:immunology / Q000302:isolation & purification*; D012612:Scrub Typhus / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D012640:Seizures / Q000209:etiology; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Himachal Pradesh; Rickettsial diseases; febrile illness; meningoencephalitis; typhus