"Neurological manifestation of scrub typhus"

Masaraf Hussain

North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India

DOI: 10.29011/2577-1442-C1-002

Scrub Typhus also known as tsutsugamushi disease is an acute febrile illness caused by Orientia tsutsugamushi. It is a mite borne disease characterized by fever with headache, suffused face, lymphadenopathy, eschar, multi organ involvement and a rapid response to Doxycycline.

Our study of the neurological involvement of Scrub typhus, showed both direct and immune mediated involvement. Direct involvement was as follows: meningitis, meningoencephalitis, encephalitis, encephalopathy, seizure, stroke. Immune mediated involvement was as follows: optic neuritis, myelitis, acute disseminated encephalomyelitis, neuropathy.

This was a retrospective study carried out in Department of Neurology, NEIGRIHMS, Shillong for a duration of one year. Total 17 patients had Scrub Typhus with neurological manifestation. Fever was found in all patients. The headache was present in 12 (70.5%), seizure in 5(29.4%), meningoencephalitis in 6 (35.2%), optic neuritis in 4 (23.5%), myelitis in 1 (5%), ADEM (acute disseminated encephalomyelitis) in 2 (11.7%). The cases were diagnosed clinically by presence of fever, eschar, and nervous system involvement. Laboratory investigation was done with Weil Felix test and ELISA (IgG and IgM). Neuroimaging and Cerebrospinal fluid analysis was also done.

Most patients responded to Doxycycline. Few complicated cases required addition of Chloramphenicol.

Masaraf Hussain has Completed M.B.B.S. and M.D.(Medicine) from N.S.C.B. Medical College, Jabalpur, India, and D.M. (Neurology) from Gauhati Medical College, Assam, India. He is presently working as an Assistant Professor, Department of Neurology, NEIGRIHMS, Shillong, India. His research interests include Neuro-infections and Cognitive disorders.