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Konyak BM, Soni M, Saikia S, Chang T, Gogoi I, Khongstid I, Chang CM, Sharma M, Pandey RP. Scrub typhus in Northeast India: epidemiology, clinical presentations, and diagnostic approaches. Trans R Soc Trop Med Hyg 2024; 118:206-222. [PMID: 37972992 DOI: 10.1093/trstmh/trad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Scrub typhus is one of the most neglected tropical diseases, a leading cause of acute undifferentiated febrile illness in areas of the 'tsutsugamushi triangle', diagnosed frequently in South Asian countries. The bacteria Orientia tsutsugamushi is the causative agent of the disease, which enters the human body through the bite of trombiculid mites (also known as chiggers) of the genus Leptotrombidium deliense. Diagnosis of the disease is challenging, as its early symptoms mimic other febrile illnesses like dengue, influenza and corona viruses. Lack of rapid, reliable and cost-effective diagnostic methods further complicates the identification process. Northeast India, a mountainous region with a predominantly rural tribal population, has witnessed a resurgence of scrub typhus cases in recent years. Various ecological factors, including rodent populations, habitat characteristics and climatic conditions, influence its prevalence. Entomological investigations have confirmed the abundance of vector mites, highlighting the importance of understanding their distribution and the probability of transmission of scrub typhus in the region. Proper diagnosis, awareness campaigns and behavioural interventions are essential for controlling scrub typhus outbreaks and reducing its impact on public health in Northeast India. Further research and community-based studies are necessary to accurately assess the disease burden and implement effective prevention strategies.
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Affiliation(s)
- Beyau M Konyak
- Integrated Molecular Diagnostic and Research Laboratory (BSL-2), District Hospital Tuensang, Tuensang-798612, Nagaland, India
- Department of Biosciences, Assam Don Bosco University, Tapesia Garden, Sonapur, Guwahati-782402, Assam, India
| | - Monika Soni
- Department of Biosciences, Assam Don Bosco University, Tapesia Garden, Sonapur, Guwahati-782402, Assam, India
| | - Shyamalima Saikia
- Department of Life Sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
| | - Tochi Chang
- Integrated Molecular Diagnostic and Research Laboratory (BSL-2), District Hospital Tuensang, Tuensang-798612, Nagaland, India
| | - Indrani Gogoi
- Department of Life Sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
| | - Ibakmensi Khongstid
- Department of Biosciences, Assam Don Bosco University, Tapesia Garden, Sonapur, Guwahati-782402, Assam, India
| | - Chung-Ming Chang
- Master's and PhD Program in Biotechnology Industry, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan District, Taoyuan City-33302, Taiwan (ROC)
- Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan District, Taoyuan City-33302, Taiwan (ROC)
| | - Mohan Sharma
- Integrated Molecular Diagnostic and Research Laboratory (BSL-2), District Hospital Tuensang, Tuensang-798612, Nagaland, India
| | - Ramendra Pati Pandey
- School of Health Sciences and Technology, UPES, Dehradun-248007, Uttarakhand, India
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Tasak N, Apidechkul T, Law ACK, Abdad MY, Srichan P, Perrone C, Tanganuchitcharnchai A, Wongsantichon J, Blacksell SD. Prevalence of and factors associated with scrub typhus exposure among the hill tribe population living in high incidence areas in Thailand: a cross-sectional study. BMC Public Health 2023; 23:2394. [PMID: 38041104 PMCID: PMC10693027 DOI: 10.1186/s12889-023-17313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Scrub typhus is a significant tropical disease, occurring in rural settings and therefore usually afflicting remote agricultural populations who have lower socioeconomic status and limited access to medical care. A large proportion of the hill tribe people in Thailand are financially poor, have limited education, and do not have adequate health care access. This study aimed to estimate the prevalence of and determine factors associated with scrub typhus exposure among the hill tribe population living in high-incidence areas in northern Thailand. METHODS A cross-sectional study design was used to gather information from hill tribe people aged 18 years and over living in ten hill tribe villages in Mae Fah Luang, Chiang Rai Province, Thailand. Participants who met the inclusion criteria were invited to participate in the study. A validated questionnaire was used as the research instrument, and 5 mL blood samples were taken. Orientia tsutsugamushi IgM and IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA) and then confirmed by immunofluorescence assay (IFA). Logistic regression was used to detect associations between variables at a significance level of α = 0.05. RESULTS A total of 485 hill tribe people participated in the study; 57.1% were female, 29.9% were over 60 years of age, 46.4% were from the Akha tribe, and 74.2% had never attended school. The overall prevalence of scrub typhus exposure was 48.0%. In the multivariate model, five variables were found to be associated with scrub typhus exposure. Participants aged over 60 years had a 4.31-fold increased risk (95% CI = 1.73-10.72) of scrub typhus exposure compared to those who were younger than 30 years. Those who were illiterate had a 3.46-fold increased risk (95% CI = 1.93-6.21) of scrub typhus exposure than those who had at least a primary education level. Participants from the Akha tribe had a 2.20-fold increased risk (95% CI = 1.31-3.72) of scrub typhus exposure than those from the Lahu tribe. Subjects who had a history of cutting grass had a 1.85-fold increased risk (95% CI = 1.20-2.84) of scrub typhus exposure. Those who never wore gloves for farming had a 2.12-fold increased risk (95% CI = 1.28-3.49) of scrub typhus exposure than those who wore gloves daily. CONCLUSIONS There is a high prevalence of scrub typhus exposure among the hill tribe in Thailand. Effective public health interventions to promote scrub typhus awareness and prevention are urgently needed in these populations.
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Affiliation(s)
- Nidanuch Tasak
- School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Tawatchai Apidechkul
- School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand.
- Center of Excellence, The Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand.
| | - Andrew C K Law
- Department of Psychiatry, Royal College of Surgeons in Ireland & University College Dublin, (Malaysia Campus), Pulau Pinang, Malaysia
| | - Mohammad Yazid Abdad
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Peeradone Srichan
- School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand
- Center of Excellence, The Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand
| | - Carlo Perrone
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | - Stuart D Blacksell
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Vanramliana, Pautu L, Lalmalsawma P, Rosangkima G, Sarma DK, Chinzah H, Malvi Y, Kodali NK, Amarthaluri C, Balasubramani K, Balabaskaran Nina P. Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India. PLoS Negl Trop Dis 2023; 17:e0011688. [PMID: 37910591 PMCID: PMC10642901 DOI: 10.1371/journal.pntd.0011688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/13/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND In the past decade, scrub typhus cases have been reported across India, even in regions that had no previous history of the disease. In the North-East Indian state of Mizoram, scrub typhus cases were first recorded only in 2012. However, in the last five years, the state has seen a substantial increase in the scrub typhus and other rickettsial infections. As part of the public health response, the Mizoram Government has integrated screening and line listing of scrub typhus and other rickettsial infections across all its health settings, a first in India. Here we detail the epidemiology of scrub typhus and other rickettsial infections from 2018-2022, systematically recorded across the state of Mizoram. METHODOLOGY/PRINCIPAL FINDINGS The line-listed data positive for scrub typhus and other rickettsial infections identified by rapid immunochromatographic test and/or Weil-Felix test from 2018-22 was used for the analysis. During this period, 22,914 cases of rickettsial infections were recorded, out of which 19,651 were scrub typhus cases. Aizawl is the worst affected, with 10,580 cases (46.17%). The average incidence of rickettsial infections is 3.54 cases per 1000 persons-year, and the case fatality rate is 0.35. Only ∼2% of the reported scrub typhus cases had eschar. Multivariate logistic regression analysis indicate patients with eschar (aOR = 2.5, p<0.05), occupational workers [farmers (aOR:3.9), businessmen (aOR:1.8), construction workers (aOR:17.9); p<0.05], and children (≤10 years) (aOR = 5.4, p<0.05) have higher odds of death due to rickettsial infections. CONCLUSION The integration of systematic surveillance and recording of rickettsial diseases across Mizoram has shed important insights into their prevalence, morbidity, and mortality. This study underscores the importance of active surveillance of rickettsial infections across India, as the burden could be substantially higher, and is probably going undetected.
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Affiliation(s)
- Vanramliana
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
| | - Lalfakzuala Pautu
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
- Integrated Disease Surveillance Programme, Health & Family Welfare Department, Mizoram, India
| | - Pachuau Lalmalsawma
- Integrated Disease Surveillance Programme, Health & Family Welfare Department, Mizoram, India
| | - Gabriel Rosangkima
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
| | - Devojit Kumar Sarma
- ICMR- National Institute for Research in Environmental Health, Bhopal Bypass Road, Bhauri, Bhopal, Madhya Pradesh, India
| | - Hunropuia Chinzah
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
| | - Yogesh Malvi
- Integrated Disease Surveillance Programme, Health & Family Welfare Department, Mizoram, India
| | - Naveen Kumar Kodali
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Christiana Amarthaluri
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | | | - Praveen Balabaskaran Nina
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
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Alam AM, Gillespie CS, Goodall J, Damodar T, Turtle L, Vasanthapuram R, Solomon T, Michael BD. Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality. PLoS Negl Trop Dis 2022; 16:e0010952. [PMID: 36441812 PMCID: PMC9731453 DOI: 10.1371/journal.pntd.0010952] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/08/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Scrub typhus has become a leading cause of central nervous system (CNS) infection in endemic regions. As a treatable condition, prompt recognition is vital. However, few studies have focused on describing the symptomology and outcomes of neurological scrub typhus infection. We conducted a systematic review and meta-analysis to report the clinical features and case fatality ratio (CFR) in patients with CNS scrub typhus infection. METHODS A search and analysis plan was published in PROSPERO [ID 328732]. A systematic search of PubMed and Scopus was performed and studies describing patients with CNS manifestations of proven scrub typhus infection were included. The outcomes studied were weighted pooled prevalence (WPP) of clinical features during illness and weighted CFR. RESULTS Nineteen studies with 1,221 (656 adults and 565 paediatric) patients were included. The most common clinical features in CNS scrub typhus were those consistent with non-specific acute encephalitis syndromes (AES), such as fever (WPP 100.0% [99.5%-100.0%, I2 = 47.8%]), altered sensorium (67.4% [54.9-78.8%, I2 = 93.3%]), headache (65.0% [51.5-77.6%, I2 = 95.1%]) and neck stiffness 56.6% (29.4-80.4%, I2 = 96.3%). Classical features of scrub typhus were infrequently identified; an eschar was found in only 20.8% (9.8%-34.3%, I2 = 95.4%) and lymphadenopathy in 24.1% (95% CI 11.8% - 38.9%, I2 = 87.8%). The pooled CFR (95% CI) was 3.6% (1.5%- 6.4%, I2 = 67.3%). Paediatric cohorts had a CFR of 6.1% (1.9-12.1%, I2 = 77%) whilst adult cohorts reported 2.6% (0.7-5.3%, I2 = 43%). CONCLUSION Our meta-analyses illustrate that 3.6% of patients with CNS manifestations of scrub typhus die. Clinicians should have a high index of suspicion for scrub typhus in patients presenting with AES in endemic regions and consider starting empiric treatment whilst awaiting results of investigations, even in the absence of classical signs such as an eschar or lymphadenopathy.
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Affiliation(s)
- Ali M. Alam
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
| | - Conor S. Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jack Goodall
- Tropical & Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Tina Damodar
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lance Turtle
- Tropical & Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- The Pandemic Institute, Liverpool, United Kingdom
- The NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Ravi Vasanthapuram
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Tom Solomon
- The Pandemic Institute, Liverpool, United Kingdom
- The NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Benedict D. Michael
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- The NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Sen S, Nayak B, Parija S. Bilateral optic disc edema with subconjunctival hemorrhage: Attributed to scrub typhus? Oman J Ophthalmol 2022; 15:99-101. [PMID: 35388247 PMCID: PMC8979387 DOI: 10.4103/ojo.ojo_262_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022] Open
Abstract
A 15-year-old female patient presented with complaints of headache, blurring of vision, and redness of both eyes for 15 days and fever for 20 days. Her best-corrected visual acuity (BCVA) was 20/40 in both eyes. Anterior segment examination was normal except for subconjunctival haemorrhage in both eyes. Examination of the posterior segment showed disc oedema in both eyes. Her blood investigations revealed platelet count to be 1.5 lakhs per cubic mm, and leucocyte count to be10,700 per cubic mm. CSF culture showed seven cells per microlitre,76% lymphocytes and CSF samples negative for gram stain, acid-fast bacilli, and culture. Further investigation for IgM titre for scrub typhus was positive. She was treated with oral doxycycline. On follow up after three weeks, both the subconjunctival haemorrhage and bilateral disc oedema resolved with BCVA of 20/20 in both eyes. She was kept on follow up and has not presented with any fresh complaints until six months after the initial presentation."
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Affiliation(s)
- Saswati Sen
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Saswati Sen, Department of Ophthalmology, AIIMS, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Bhagabat Nayak
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
| | - Sucheta Parija
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
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Behera B, Satapathy AK, Ranjan J, Chandrasekar S, Patel S, Mishra B, Mahapatro S, Das RR. Profile of Scrub Typhus Meningitis/Meningoencephalitis in Children with and without Scrub Typhus IgM Antibody in CSF. J Neurosci Rural Pract 2021; 12:786-791. [PMID: 34737516 PMCID: PMC8559072 DOI: 10.1055/s-0041-1734003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this article was to study the spectrum of scrub typhus meningitis/meningoencephalitis (STM) cases in children. Children ≤14 years of age with acute undifferentiated febrile illness were included. Immunoglobulin M (IgM) enzyme-linked immunosorbent assay was done in blood and cerebrospinal fluid (CSF) of children with suspected STM. Demographic, clinical, and laboratory details were expressed as descriptive statistics. Factors associated with neurological involvement were identified on univariate analysis. A total of 76 children had ST during the study period (meningitis/meningoencephalitis = 8 [10.5%], of which 5 [62.5%] had detectable ST IgM antibodies in CSF). The included children were 4 to 12 years of age with boys > girls. Headache and vomiting were common in those with STM, whereas hyponatremia and thrombocytopenia were common in those without STM. All children with STM recovered with sequelae in one child (right lateral rectus palsy). There was no mortality. STM has an incidence of 10.5% in children with ST from Eastern India. Headache and vomiting were significant predictors of STM, whereas hyponatremia and thrombocytopenia were significant predictor of non-STM.
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Affiliation(s)
- Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amit Kumar Satapathy
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jai Ranjan
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Shyam Chandrasekar
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Subhakanta Patel
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Samarendra Mahapatro
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Loganathan SK, Jaybhaye A, Dash N, Punnen A, Ghosh U, Rose W. Acute respiratory distress syndrome in paediatric scrub typhus. Trop Doct 2021; 51:514-517. [PMID: 34238058 DOI: 10.1177/00494755211029146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute respiratory distress syndrome is a life-threatening complication of scrub typhus; we sought to describe its mortality and associated factors, namely eschar, hepatomegaly and severe thrombocytopenia, in a retrospective study in India of 65 children.
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Affiliation(s)
| | - Amol Jaybhaye
- Post-Doctoral Fellowship in Paediatric Infectious Disease, CMC, Vellore, India
| | - Nabaneeta Dash
- Post-Doctoral Fellow in Paediatric Infectious Disease, CMC, Vellore, India
| | - Anu Punnen
- Associate Professor, Department of Paediatrics, CMC, Vellore, India
| | - Urmi Ghosh
- Assistant Professor, Department of Paediatrics, CMC, Vellore, India
| | - Winsley Rose
- Professor, Department of Paediatrics (Paediatric Infectious Disease), CMC, Vellore, India
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Garg D, Manesh A. Neurological facets of scrub typhus: A comprehensive narrative review. Ann Indian Acad Neurol 2021; 24:849-864. [PMID: 35359522 PMCID: PMC8965938 DOI: 10.4103/aian.aian_739_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Scrub typhus is one of the most frequent causes of acute febrile illness in South and South-east Asian countries. Neurological features accompany 20% of scrub typhus infections, and may affect the central or peripheral nervous system, and sometime, may even occur in combination. Of late, its recognition among clinicians has increased with widening detection of its cutaneous hallmark, called eschar. Multiple mechanisms underlie neurological involvement, including direct invasion (meningitis, encephalitis), vasculitis (myositis) or immune-mediated mechanisms (opsoclonus, myoclonus, optic neuritis, Guillain–Barre syndrome). Despite an immunological basis for several neurological manifestations, response to doxycycline is remarkable, although immune therapy may be necessary for severe involvement. Scientific literature on scrub typhus neurology chiefly emanates from case reports, case series and small studies, and a comprehensive review is warranted to aid clinicians in recognising neurological involvement. This review aims at enriching this gap, and summarises clinical features, laboratory findings, and treatment options for various neurological facets of scrub typhus.
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Patnaik S, Parida P, Agrawal A, Biswal S, Behera C. Scrub typhus meningoencephalitis in children: A single centre, observational study from Eastern India. JOURNAL OF PEDIATRIC CRITICAL CARE 2021. [DOI: 10.4103/jpcc.jpcc_74_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alam A, Agarwal P, Prabha J, Jain A, Kalyan RK, Kumar C, Kumar R. Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India. J Child Neurol 2020; 35:820-827. [PMID: 32580611 DOI: 10.1177/0883073820933148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the proportion of scrub typhus meningoencephalitis among children with acute encephalitis syndrome and to outline its differentiating features. To develop a prediction rule for scrub typhus meningoencephalitis. METHODS A prospective cohort study was conducted at a tertiary care public hospital in Northern India. Consecutive patients of acute encephalitis syndrome who met our inclusion criteria were enrolled over 2 years. Standardized workup including serum IgM against Orientia tsutsugamushi was performed. Clinical and laboratory features were compared between IgM-positive and IgM-negative patients. The area under the receiver operating characteristic curve of the score derived from "independent predictors" was measured. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated at different cut-offs of the score. RESULTS Scrub typhus IgM enzyme-linked immunosorbent assay was positive in 66/352 patients (18.8%). Longer duration of fever and prodromal stage along with eschar, hepatomegaly, lymphadenopathy, and pneumonia were significantly more prevalent in scrub typhus meningoencephalitis. However, petechiae were frequent in non-scrub typhus patients. Leucocytosis, lymphocytosis, thrombocytopenia, hypoalbuminemia, and elevated levels of serum bilirubin, serum transaminases, and cerebrospinal fluid protein were associated with scrub typhus meningoencephalitis. Logistic regression revealed fever for >8 days, pneumonia, absence of petechiae, cerebrospinal fluid protein >1000 mg/L, and serum glutamic oxaloacetic transaminase >100 IU/L as independent "predictors" of scrub typhus meningoencephalitis. The area under the receiver operating characteristic curve (95% confidence interval) of the prediction score was 0.832 (0.78-0.89). Score at cutoff ≥1 had 91% sensitivity, 96.1% negative predictive value, and at cutoff ≥4 had 99.7% specificity, 88.9% positive predictive value, 83.1% negative predictive value, 40.3 positive likelihood ratio, 0.88 negative likelihood ratio for identifying scrub typhus meningoencephalitis. CONCLUSION Prediction score may help physicians in peripheral areas to identify and treat scrub typhus meningoencephalitis, an emerging cause of acute encephalitis syndrome in India.
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Affiliation(s)
- Areesha Alam
- Department of Pediatrics, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Pranshi Agarwal
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jayanti Prabha
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Raj Kumar Kalyan
- Department of Microbiology, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chandrakanta Kumar
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kumar
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
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Li W, Huang L, Zhang W. Scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia: a case report and review of the literature. J Med Case Rep 2019; 13:358. [PMID: 31810465 PMCID: PMC6898947 DOI: 10.1186/s13256-019-2299-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 10/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scrub typhus is an acute infectious zoonotic disease caused by Orientia tsutsugamushi. Multi-organ dysfunction secondary to scrub typhus is hard to diagnose and has a high mortality rate. Only one case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia has been reported thus far. In this study, we report a second case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia, and we summarize its diagnosis and treatment. CASE PRESENTATION A 43-year-old Han Chinese woman, a sanitation worker, was admitted to our hospital after 7 days of a skin infection and 5 days of a sore throat with fever and dizziness. A physical examination revealed the presence of an eschar on the right side of her neck. She had a history of insect bites during her sanitation work. A diagnostic evaluation identified scrub typhus as the primary illness, which was associated with multi-organ dysfunction syndrome and immune thrombocytopenia. She recovered completely after 15 days of treatment and extensive symptomatic supportive care. CONCLUSION We report a second case of tsutsugamushi disease with multi-organ dysfunction syndrome and immune thrombocytopenia, which resolved after treatment and extensive care.
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Affiliation(s)
- Weijia Li
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Lei Huang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
| | - Weixing Zhang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
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Prolonged coma in a scrub typhus patient. Int J Infect Dis 2018; 77:5-7. [PMID: 30248463 DOI: 10.1016/j.ijid.2018.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/21/2022] Open
Abstract
Central nervous system symptoms occur in more than 80% of patients with scrub typhus infection; however, the entity of central nervous system involvement is still not fully understood. We present the case of a patient with fulminant scrub typhus with multiple organ failure, including prolonged deep coma, and detail the sequential neurological symptoms, signs, laboratory data, and neuroradiological findings.
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Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India. PLoS Negl Trop Dis 2018; 12:e0006346. [PMID: 29590177 PMCID: PMC5891077 DOI: 10.1371/journal.pntd.0006346] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 04/09/2018] [Accepted: 02/25/2018] [Indexed: 01/30/2023] Open
Abstract
Background Acute Encephalitis Syndrome (AES) is a major seasonal public health problem in Bihar, India. Despite efforts of the Bihar health department and the Government of India, burden and mortality of AES cases have not decreased, and definitive etiologies for the illness have yet to be identified. Objectives The present study was undertaken to study the specific etiology of AES in Bihar. Methods Cerebrospinal fluid and/or serum samples from AES patients were collected and tested for various pathogens, including viruses and bacteria by ELISA and/or Real Time PCR. Findings Of 540 enrolled patients, 33.3% (180) tested positive for at least one pathogen of which 23.3% were co-positive for more than one pathogen. Most samples were positive for scrub typhus IgM or PCR (25%), followed by IgM positivity for JEV (8.1%), WNV (6.8%), DV (6.1%), and ChikV (4.5%).M. tuberculosis and S. pneumoniae each was detected in ~ 1% cases. H. influenzae, adenovirus, Herpes Simplex Virus -1, enterovirus, and measles virus, each was detected occasionally. The presence of Scrub typhus was confirmed by PCR and sequencing. Bihar strains resembled Gilliam-like strains from Thailand, Combodia and Vietnam. Conclusion The highlights of this pilot AES study were detection of an infectious etiology in one third of the AES cases, multiple etiologies, and emergence of O. tsutsugamushi infection as an important causative agent of AES in India. Acute encephalitis syndrome (AES) is a dreaded disease in India including the state of Bihar. Every year several people specially children, succumb to this disease and often the survivors are left with permanent residual disorders. The present research throws light on specific etiological agents that may cause AES and have found scrub typhus to be an important etiology. Knowing the specific etiology would help in definitive management of the patients that may improve the outcome both in terms of morbidity and mortality, as well as help the policy makers to take specific action for prevention and control of the disease.
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Tshokey T, Stenos J, Durrheim DN, Eastwood K, Nguyen C, Graves SR. Seroprevalence of rickettsial infections and Q fever in Bhutan. PLoS Negl Trop Dis 2017; 11:e0006107. [PMID: 29176880 PMCID: PMC5720829 DOI: 10.1371/journal.pntd.0006107] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/07/2017] [Accepted: 11/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background With few studies conducted to date, very little is known about the epidemiology of rickettsioses in Bhutan. Due to two previous outbreaks and increasing clinical cases, scrub typhus is better recognized than other rickettsial infections and Q fever. Methodology A descriptive cross-sectional serosurvey was conducted from January to March 2015 in eight districts of Bhutan. Participants were 864 healthy individuals from an urban (30%) and a rural (70%) sampling unit in each of the eight districts. Serum samples were tested by microimmunofluorescence assay for rickettsial antibodies at the Australian Rickettsial Reference Laboratory. Results Of the 864 participants, 345 (39.9%) were males and the mean age of participants was 41.1 (range 13–98) years. An overall seroprevalence of 49% against rickettsioses was detected. Seroprevalence was highest against scrub typhus group (STG) (22.6%) followed by spotted fever group (SFG) rickettsia (15.7%), Q fever (QF) (6.9%) and typhus group (TG) rickettsia (3.5%). Evidence of exposure to multiple agents was also noted; the commonest being dual exposure to STG and SFG at 5%. A person’s likelihood of exposure to STG and SFG rickettsia significantly increased with age and farmers were twice as likely to have evidence of STG exposure as other occupations. Trongsa district appeared to be a hotspot for STG exposure while Punakha district had the lowest STG exposure risk. Zhemgang had the lowest exposure risk to SFG rickettsia compared to other districts. People living at altitudes above 2000 meters were relatively protected from STG infections but this was not observed for SFG, TG or QF exposure. Conclusion This seroprevalence study highlights the endemicity of STG and SFG rickettsia in Bhutan. The high seroprevalence warrants appropriate public health interventions, such as diagnostic improvements and clinical treatment guidelines. Future studies should focus on vector profiles, geospatial, bio-social and environmental risk assessment and preventive and control strategies. Rickettsial infections including scrub typhus and Q fever are not widely recognised in Bhutan although the country is situated in an endemic Asian region. With two recorded outbreaks, scrub typhus is known to occur but other rickettsial infections and Q fever have not been recorded. In this first seroprevalence study of rickettsial infections, an overall seroprevalence of 49% was detected against rickettsioses amongst 864 participants. Seroprevalence was highest against scrub typhus group (STG) (22.6%) followed by spotted fever group (SFG) rickettsia (15.7%), Q fever (QF) (6.9%) and typhus group (TG) rickettsia (3.5%). Evidence of exposure to multiple agents were also noted; the commonest being dual exposure to STG and SFG at 5%. A person’s likelihood of exposure to STG and SFG significantly increased with age and farmers were twice as likely to have evidence of STG exposure as other occupations. Trongsa district in central Bhutan appeared to be a hotspot for STG exposure. People living at altitudes above 2000 meters were relatively protected from STG infections but this was not observed for SFG, TG and QF exposure. The findings from this study may direct future research on rickettsioses in Bhutan. These neglected tropical diseases warrant specific public health interventions in Bhutan.
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Affiliation(s)
- Tshokey Tshokey
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
- Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- * E-mail:
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - David N. Durrheim
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Population Health, Hunter New England Local Health District, NSW Health, Newcastle, Australia
| | - Keith Eastwood
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Population Health, Hunter New England Local Health District, NSW Health, Newcastle, Australia
| | - Chelsea Nguyen
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Stephen R. Graves
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
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Abstract
OBJECTIVE To compare the children admitted with scrub typhus with and without meningitis. METHODS All children admitted with scrub typhus over a 62 mo period were reviewed. Statistical analysis was performed to compare those with and without meningitis for demographic, clinical, investigations and outcome parameters. RESULTS Four hundred twenty seven children were admitted with scrub typhus and 63 (14.8%) had meningitis. The mean cerebrospinal fluid white blood cell (CSF WBC) count was 71 cells/cu.mm. with mean lymphocyte proportion of 92%. The mean CSF protein was 67 mg/dl and mean CSF glucose, 55 mg/dl. Of those who had meningitis, 24 (38.1%) had seizures, 17 (27%) had altered sensorium and 37 (58.7%) had nuchal rigidity. Finding an eschar, being male, breathing difficulty, and hepatomegaly were significantly more common in those without meningitis. Children with meningitis also had shorter duration of fever at presentation (median [IQR] 7 [3] days vs. 10 [4] days; p = 0.028). Headache and vomiting were significantly more common in those with meningitis. Hemoglobin and platelet were significantly lower in those without meningitis. Duration of hospitalization was significantly longer in those with meningitis, whereas acute respiratory distress syndrome (ARDS) was significantly more common in those without meningitis. There was no neurological deficit in both the groups. There was no mortality in the meningitis group compared to 3.6% mortality in the non-meningitis group (p = 0.213). CONCLUSIONS Meningitis occurs in 15% of those with scrub typhus; those with meningitis have good neurological outcome with little mortality; those without meningitis have more complications and poorer outcome.
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Soong L, Shelite TR, Xing Y, Kodakandla H, Liang Y, Trent BJ, Horton P, Smith KC, Zhao Z, Sun J, Bouyer DH, Cai J. Type 1-skewed neuroinflammation and vascular damage associated with Orientia tsutsugamushi infection in mice. PLoS Negl Trop Dis 2017; 11:e0005765. [PMID: 28742087 PMCID: PMC5542690 DOI: 10.1371/journal.pntd.0005765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/03/2017] [Accepted: 06/30/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Scrub typhus is a life-threatening disease, due to infection with O. tsutsugamushi, a Gram-negative bacterium that preferentially replicates in endothelial cells and professional phagocytes. Meningoencephalitis has been reported in scrub typhus patients and experimentally-infected animals; however, the neurological manifestation and its underlying mechanisms remain poorly understood. To address this issue, we focused on Orientia tsutsugamushi Karp strain (OtK), and examined host responses in the brain during lethal versus self-healing scrub typhus disease in our newly established murine models. PRINCIPLE FINDINGS Following inoculation with a lethal dose of OtK, mice had a significant increase in brain transcripts related to pathogen-pattern recognition receptors (TLR2, TLR4, TLR9), type-1 responses (IFN-γ, TNF-α, CXCL9, CXCR3), and endothelial stress/damage such as angiopoietins, but a rapid down-regulation of Tie2. Sublethal infection displayed similar trends, implying the development of type 1-skewed proinflammatory responses in infected brains, independent of time and disease outcomes. Focal hemorrhagic lesions and meningitis were evident in both infection groups, but pathological changes were more diffuse and frequent in lethal infection. At 6-10 days of lethal infection, the cortex and cerebellum sections had increased ICAM-1-positive staining in vascular cells, as well as increased detection of CD45+ leukocytes, CD3+ T cells, IBA1+ phagocytes, and GFAP+ astrocytes, but a marked loss of occludin-positive tight junction staining, implying progressive endothelial activation/damage and cellular recruitment in inflamed brains. Orientia were sparse in the brains, but readily detectable within lectin+ vascular and IBA-1+ phagocytic cells. These CNS alterations were consistent with type 1-skewed, IL-13-suppressed responses in lethally-infected mouse lungs. SIGNIFICANCE This is the first report of type 1-skewed neuroinflammation and cellular activation, accompanied with vascular activation/damage, during OtK infection in C57BL/6 mice. This study not only enhances our understanding of the pathophysiological mechanisms of scrub typhus, but also correlates the impact of immune and vascular dysfunction on disease pathogenesis.
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Affiliation(s)
- Lynn Soong
- Department of Microbiology and Immunology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
| | - Thomas R. Shelite
- Department of Microbiology and Immunology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Internal Medicine/Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Yan Xing
- Department of Microbiology and Immunology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
- Pediatrics Department, People's Hospital of Henan Province, Zheng Zhou, Henan, China
| | - Harica Kodakandla
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Yuejin Liang
- Department of Microbiology and Immunology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Brandon J. Trent
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Paulina Horton
- Department of Microbiology and Immunology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Kathryn C. Smith
- Center in Environmental Toxicology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Zhenyang Zhao
- Department of Ophthalmology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jiaren Sun
- Department of Microbiology and Immunology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Donald H. Bouyer
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jiyang Cai
- Department of Ophthalmology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
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Khan SA, Khamo V, Uriah HJ, Bora T, Dutta P. Scrub typhus in hilly regions of north east India. Indian J Med Res 2017; 144:138-140. [PMID: 27834339 PMCID: PMC5116888 DOI: 10.4103/0971-5916.193302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Siraj A Khan
- Entomology and Filariasis Division, Arbovirology Group, Regional Medical Research Centre (ICMR), N.E. Region, Dibrugarh 786 001, Assam, India
| | - Vinotsole Khamo
- Department of Pathology & Healthcare Laboratory & Research Centre, Naga Hospital Authority, Kohima 797 001, Nagaland, India
| | - Helen J Uriah
- Integrated Disease Survelliance Programme Office, West Jaintia Hills 793 150, Meghalaya, India
| | - Trishna Bora
- Entomology and Filariasis Division, Arbovirology Group, Regional Medical Research Centre (ICMR), N.E. Region, Dibrugarh 786 001, Assam, India
| | - Prafulla Dutta
- Entomology and Filariasis Division, Arbovirology Group, Regional Medical Research Centre (ICMR), N.E. Region, Dibrugarh 786 001, Assam, India
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Aetiology of acute meningoencephalitis in Cambodian children, 2010-2013. Emerg Microbes Infect 2017; 6:e35. [PMID: 28536430 PMCID: PMC5520480 DOI: 10.1038/emi.2017.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 01/09/2023]
Abstract
Acute meningoencephalitis (AME) is associated with considerable morbidity and mortality in children in developing countries. Clinical specimens were collected from children presenting with AME at two Cambodian paediatric hospitals to determine the major aetiologies associated with AME in the country. Cerebrospinal fluid (CSF) and blood samples were screened by molecular and cell culture methods for a range of pathogens previously associated with AME in the region. CSF and serum (acute and convalescent) were screened for antibodies to arboviruses such as Japanese encephalitis virus (JEV), dengue virus (DENV), and chikungunya virus (CHIKV). From July 2010 through December 2013, 1160 children (one month to 15 years of age) presenting with AME to two major paediatric hospitals were enroled into the study. Pathogens associated with AME were identified using molecular diagnostics, cell culture and serology. According to a diagnostic algorithm, a confirmed or highly probable aetiologic agent was detected in 35.0% (n=406) of AME cases, with a further 9.2% (total: 44.2%, n=513) aetiologies defined as suspected. JEV (24.4%, n=283) was the most commonly identified pathogen followed by Orientia tsutsugamushi (4.7%, n=55), DENV (4.6%, n=53), enteroviruses (3.5%, n=41), CHIKV (2.0%, n=23) and Streptococcus pneumoniae (1.6%, n=19). The majority of aetiologies identified for paediatric AME in Cambodia were vaccine preventable and/or treatable with appropriate antimicrobials.
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Bhat NK, Pandita N, Saini M, Dhar M, Ahmed S, Shirazi N, Wasim S, Shirke R, Chandar V. Scrub Typhus: A Clinico-Laboratory Differentiation of Children with and without Meningitis. J Trop Pediatr 2016; 62:194-9. [PMID: 26851433 DOI: 10.1093/tropej/fmv097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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.
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Affiliation(s)
- Nowneet Kumar Bhat
- Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Neerul Pandita
- Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Manju Saini
- Department of Radio Diagnosis, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Minakshi Dhar
- Department of Medicine, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Sohaib Ahmed
- Department of Medicine, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Nadia Shirazi
- Department of Pathology, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Sanober Wasim
- Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Rupali Shirke
- Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
| | - Vipan Chandar
- Department of Paediartics, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, 248140, Uttarakhand, India
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