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      First case of scrub typhus with meningoencephalitis from Kerala: An emerging infectious threat

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          Abstract

          Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi, one of the most common infectious diseases in the Asia-Pacific region. It has been reported from northern, eastern, and southern India, and its presence has been documented in at least 11 Indian states. However, scrub typhus meningoencephalitis has not been well documented in Kerala. We report two cases of scrub typhus meningoencephalitis from northern Kerala. The diagnosis was made based on the clinical pictures, presence of eschar, and a positive Weil–Felix test with a titer of > 1:320. The first patient succumbed to illness due to respiratory failure and the second patient improved well.

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          Outbreak of scrub typhus in southern India during the cooler months.

          E Mathai, M Mathai, O Abraham … (2003)
          Orientia tsutsugamushi, the agent of scrub typhus, is a strict intracellular bacterium which is found in many parts of Asia including India. During the past few years, the number of patients with rickettsial infection and scrub typhus has increased, especially during the cooler months. We report in this study a recent outbreak of scrub typhus recorded during the cooler months (October 2001 to February 2002) in patients admitted to our hospital with acute febrile illness associated with diverse signs and symptoms. Overall, 28 patients were clinically and serologically confirmed to have scrub typhus. Fever for more than one week was the only common manifestation. Myalgias was the next most common feature (52%), and rash was observed in only 22% of the cases. Seventeen patients treated with doxycycline recovered in 1 to 3 days, as well as two patients who received chloramphenicol. In five patients who received ciprofloxacin, fever subsided only after five days. Finally three patients (10.7%) died, including one patient treated with doxycycline. These data indicate that scrub typhus is a reemerging infectious disease in India with a possibility of drug resistance. This reemergence emphasizes the need for further prospective studies to design effective control measures.
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            Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality.

            Anugrah Chrispal, Kurien Thomas, Jini K. Gopinath … (2010)
            Scrub typhus is an important cause of acute undifferentiated febrile illnesses in the Indian subcontinent. Delay in diagnosis and in the initiation of appropriate treatment can result in severe complications such as acute respiratory distress syndrome (ARDS), septic shock and multisystem organ failure culminating in death. We conducted a prospective, observational study to delineate the clinical profile and predictors of mortality in scrub typhus in adults admitted to the medical wards of a tertiary care, referral hospital in South India over a one-year period. The case fatality rate in this study was 12.2%. Metabolic acidosis (odds ratio [OR] 6.1), ARDS (OR 3.6), altered sensorium (OR 3.6) and shock (OR 3.1) were independent predictors of mortality. It appears that scrub typhus has four possible overlapping clinical presentations: mild disease; respiratory predominant disease; central nervous system predominant disease (meningoencephalitis); or sepsis syndrome. Given the telltale presence of an eschar (evident in 45.5%), the characteristic clinical profile and the dramatic therapeutic response to a cheap, yet effective, drug such as doxycycline, medical practitioners in the region should have ample opportunity to reach an early diagnosis and initiate treatment which could, potentially, reduce the mortality and morbidity associated with scrub typhus.
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              Scrub Typhus in Himalayas

              Sanjay K. Mahajan, Jean Marc Rolain, Rajesh-Shanker Kashyap … (2006)
              Himachal Pradesh state of India is situated in the outer Himalayan ranges. During the rainy season, several cases of acute febrile illness of unknown origin occurred. Orientia tsutsugamushi was identified as the causative agent by microimmunofluorescence and PCR. Two new genotypes of O. tsutsugamushi were identified in the region.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Indian Acad Neurol
                Journal ID (iso-abbrev): Ann Indian Acad Neurol
                Journal ID (publisher-id): AIAN
                Title: Annals of Indian Academy of Neurology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-2327
                ISSN (Electronic): 1998-3549
                Publication date (Print): Apr-Jun 2012
                Volume: 15
                Issue: 2
                Pages: 141-144
                Affiliations
                [1 ]Department of Neurology, Medical College, Calicut, Kerala, India
                [2 ]Department of Medicine, Medical College, Calicut, Kerala, India
                Author notes
                For correspondence: Dr. K. Saifudheen, Department of Neurology, Medical College, Calicut - 673 008, Kerala, India. E-mail: drsaifu@ 123456yahoo.co.in
                Article
                Publisher ID: AIAN-15-141
                DOI: 10.4103/0972-2327.95002
                PMC ID: 3345595
                PubMed ID: 22566732
                SO-VID: 4865f894-379b-4c0b-a8e4-a533fb0a49e6
                Copyright © Copyright: © Annals of Indian Academy of Neurology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 December 2010
                Date revision received : 13 January 2011
                Date accepted : 08 March 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Neurology
                Keywords: rickettsia,scrub typhus,meningoencephalitis
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: rickettsia, scrub typhus, meningoencephalitis

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