Acute Encephalitis Syndrome Due to Scrub Typhus Infection in Pediatric Population: A Case Series from a Tertiary Care Center of Eastern India

Abstract

Scrub typhus, which is caused by Orientia tsutsugamushi, is a reemerging infectious disease of public health concern. The disease may be accompanied by varied clinical presentations, ranging from nonspecific fever to rapidly progressing multiorgan failure. Scrub typhus is one of the less commonly diagnosed causes of acute encephalitis syndrome, especially in the pediatric population. Here, we report a series of three cases of pediatric acute encephalitis syndrome due to scrub typhus infection from a tertiary care center of Eastern India. All the three cases presented with an abrupt onset of symptoms and underwent a stormy disease course requiring intensive care support. All of them responded promptly to intravenous doxycycline treatment; however, recovery was mostly accompanied by neurologic sequelae.

Keywords

scrub typhus - acute encephalitis syndrome - intensive care

• References

• 1 Misra UK, Kalita J, Mani VE. Neurological manifestations of scrub typhus. J Neurol Neurosurg Psychiatry 2015; 86 (7) 761-766
• 2 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 (2) 141-144
• 3 Mathai E, Rolain JM, Verghese GM , et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci 2003; 990: 359-364
• 4 Sharma A, Mahajan S, Gupta ML, Kanga A, Sharma V. Investigation of an outbreak of scrub typhus in the Himalayan region of India. Jpn J Infect Dis 2005; 58 (4) 208-210
• 5 World Health Organization. Acute encephalitis syndrome. Japanese encephalitis surveillance standards. January 2006. From WHO-recommended standards for surveillance of selected vaccine-preventable diseases. WHO/V&B/03.01. Available at http://apps.who.int/iris/bitstream/10665/68334/1/WHO_V-B_03.01_eng.pdf . Accessed on August 2, 2016
• 6 Rungta N. Scrub typhus: emerging cause of multiorgan dysfunction. Indian J Crit Care Med 2014; 18 (8) 489-491
• 7 Mahajan SK, Rolain JM, Kanga A, Raoult D. Scrub typhus involving central nervous system, India, 2004-2006. Emerg Infect Dis 2010; 16 (10) 1641-1643
• 8 Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in South India—a retrospective study. PLoS ONE 2013; 8 (6) e66595
• 9 Sankhyan N, Saptharishi LG, Sasidaran K, Kanga A, Singhi SC. Clinical profile of scrub typhus in children and its association with hemophagocytic lymphohistiocytosis. Indian Pediatr 2014; 51 (8) 651-653
• 10 Kar A, Dhanaraj M, Dedeepiya D, Harikrishna K. Acute encephalitis syndrome following scrub typhus infection. Indian J Crit Care Med 2014; 18 (7) 453-455
• 11 Yum KS, Na SJ, Lee KO, Ko JH. Scrub typhus meningo-encephalitis with focal neurologic signs and associated brain MRI abnormal findings: literature review. Clin Neurol Neurosurg 2011; 113 (3) 250-253
• 12 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: 53-57
• 13 Han DK, Baek HJ, Shin MG, Kim JW, Kook H, Hwang TJ. Scrub typhus-associated severe hemophagocytic lymphohistiocytosis with encephalomyelitis leading to permanent sequelae: a case report and review of the literature. J Pediatr Hematol Oncol 2012; 34 (7) 531-533
• 14 Henter JI, Horne A, Aricó M , et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48 (2) 124-131