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VOLUME 18 , ISSUE 7 ( July, 2014 ) > List of Articles


Acute encephalitis syndrome following scrub typhus infection

M Dhanaraj, Ayan Kar, Devaprasad Dedeepiya, K Harikrishna

Keywords : Acute encephalitis syndrome, multidisciplinary care, renal involvement, scrub typhus

Citation Information : Dhanaraj M, Kar A, Dedeepiya D, Harikrishna K. Acute encephalitis syndrome following scrub typhus infection. Indian J Crit Care Med 2014; 18 (7):453-455.

DOI: 10.4103/0972-5229.136074

License: CC BY-ND 3.0

Published Online: 01-10-2006

Copyright Statement:  Copyright © 2014; The Author(s).


Objective: The aim was to find the incidence of acute encephalitis syndrome (AES) secondary to scrub infection and to observe the clinical, biochemical, radiological profile, and outcomes in these patients. Materials and Methods: A total of 20 consecutive patients of AES were evaluated for scrub infection using scrub typhus immunoglobulin M enzyme linked immuno-sorbant assay positivity along with the presence or absence of an eschar. Clinical profile, routine laboratory tests, cerebrospinal fluid (CSF) analysis, and neuroimaging were analyzed. Patients were treated with doxycycline and followed-up. Results: Among 20 consecutive patients with AES, 6 (30%) were due to scrub infection. They presented with acute onset fever, altered sensorium, seizures. "Eschar" was seen in 50% of patients. CSF done in two of them was similar to consistent with viral meningitis. Magnetic resonance imaging brain revealed cerebral edema, bright lesions in the putamen and the thalamus on T2-weighted and fluid-attenuated inversion recovery sequences. Renal involvement was seen in all patients. All patients responded well to oral doxycycline. Conclusion: AES is not an uncommon neurological presentation following scrub typhus infection. It should be suspected in all patients with fever, altered sensorium, and renal involvement. Oral doxycycline should be started as early as possible for better outcomes.

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  1. Frequently Asked Questions Scrub Typhus Published by the World Health Organization (WHO) Regional Office for South East Asia. Available from: [Last accessed in 2012 Aug].
  2. Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, et al. Scrub typhus: An unrecognized threat in South India-Clinical profile and predictors of mortality. Trop Doct 2010;40:129-33.
  3. Mahajan SK. Scrub typhus. J Assoc Physicians India 2005;53:954-8.
  4. Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India 2010;58:24-8.
  5. Mahajan SK, Rolain JM, Kanga A, Raoult D. Scrub typhus involving central nervous system, India, 2004-2006. Emerg Infect Dis 2010;16:1641-3.
  6. Saifudheen K, Kumar KG, Jose J, Veena V, Gafoor VA. First case of scrub typhus with meningoencephalitis from Kerala: An emerging infectious threat. Ann Indian Acad Neurol 2012;15:141-4.
  7. Hooper HA, Samuels MA. Viral infections of the nervous system, chronic meningitis, and prion diseases. In: Adam and Victor′s Principles of Neurology. 9 th ed. New Delhi: McGraw Hill Medical; 2009. p. 717.
  8. Blacksell SD, Bryant NJ, Paris DH, Doust JA, Sakoda Y, Day NP. Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: A lack of consensus leads to a lot of confusion. Clin Infect Dis 2007;44:391-40.
  9. Modi A, Atam V, Jain N, Gutch M, Verma R. The etiological diagnosis and outcome in patients of acute febrile encephalopathy: A prospective observational study at tertiary care center. Neurol India 2012;60:168-73.
  10. Chua CJ, Tan KS. Scrub typhus with central nervous system involvement: A case report with CT and MR imaging features. Neurol J South East Asia 1999;4:53-7.
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