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J Pediatr Infect Dis 2017; 12(02): 119-123
DOI: 10.1055/s-0037-1601339
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Scrub Typhus Meningitis versus Acute Bacterial Meningitis—A Clinical-Laboratory Differential Diagnosis

Nowneet Kumar Bhat
1   Department of Paediatrics, Himalayan Institute of Medical Sciences and SRH University, Doiwala, Dehradun, Uttarakhand, India
,
Vivek Ahuja
2   Department of Medicine, Himalayan Institute of Medical Sciences and SRH University, Doiwala, Dehradun, Uttarakhand, India
,
Barnali Kakati
3   Department of Microbiology, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, Uttarakhand, India
,
Garima Mittal
3   Department of Microbiology, Himalayan Institute of Medical Sciences, SRH University, Doiwala, Dehradun, Uttarakhand, India
,
Neerul Pandita
1   Department of Paediatrics, Himalayan Institute of Medical Sciences and SRH University, Doiwala, Dehradun, Uttarakhand, India
,
Sanober Wasim
1   Department of Paediatrics, Himalayan Institute of Medical Sciences and SRH University, Doiwala, Dehradun, Uttarakhand, India
,
Alpa Gupta
1   Department of Paediatrics, Himalayan Institute of Medical Sciences and SRH University, Doiwala, Dehradun, Uttarakhand, India
,
Minakshi Dhar
2   Department of Medicine, Himalayan Institute of Medical Sciences and SRH University, Doiwala, Dehradun, Uttarakhand, India
4   Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Sohaib Ahmed
2   Department of Medicine, Himalayan Institute of Medical Sciences and SRH University, Doiwala, Dehradun, Uttarakhand, India
› Author Affiliations
Further Information

Publication History

16 December 2016

20 February 2017

Publication Date:
21 March 2017 (online)

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Abstract

Neurologic involvement in scrub typhus in the form of meningitis or meningoencephalitis, and its differentiation from other forms of bacterial and viral meningitis, has not been extensively studied in pediatric population. We compared the clinical and laboratory profiles of children with scrub typhus meningitis (STM) and acute bacterial meningitis (ABM) at a university teaching hospital in North India. Twenty-seven children were diagnosed with acute meningitis over 12 months. Meningitis was diagnosed based on clinical features and abnormal cerebrospinal fluid (CSF) analysis, with either a positive IgM ELISA for scrub typhus (n = 19) or isolation of bacteria known to cause ABM from CSF (n = 8). The children with STM were significantly older (7.8 ± 4.9 vs. 4.5 ± 4.9 years; p = 0.029), had longer duration of fever (7.9 ± 2.7 vs. 3.4 ± 2.1 days; p < 0.001), and were more likely to have multisystem involvement compared with ABM group. The STM group had CSF pleocytosis of lesser magnitude (99.2 ± 103.4 vs. 1770 ± 3,333 cells/mm3; p < 0.001), a higher proportion of lymphocytes in CSF (74 ± 16 vs. 12 ± 6.8%; p < 0.001), lesser degree of protein elevation (108.4 ± 43.9 vs. 639.0 ± 546.3 mg%; p < 0.001), and higher CSF sugar level (60.8 ± 13.1 vs. 21.6 ± 11.6 mg%; p < 0.001) as compared with ABM group. Time to defervescence in children with STM was shorter. In conclusion, compared with ABM children, STM children tended to be older, usually had multisystem involvement, and had longer duration of fever but more rapid defervescence in response to appropriate antibiotics. Typical CSF findings included lymphocytic pleocytosis, moderate protein elevation, and a normal glucose concentration.

Keywords

meningitis - scrub typhus - bacterial - children - differential diagnosis

Funding

Nil.


 

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