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Datta AK, Mukherjee A, Biswas A. Post-Infective Rhombencephalitis with Bilateral Olivary Hypertrophic Degeneration. Ann Indian Acad Neurol 2024; 27:210-212. [PMID: 38751909 PMCID: PMC11093165 DOI: 10.4103/aian.aian_931_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 05/18/2024] Open
Affiliation(s)
- Amlan K. Datta
- Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Adreesh Mukherjee
- Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Atanu Biswas
- Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Liang Y, Aditi, Onyoni F, Wang H, Gonzales C, Sunyakumthorn P, Wu P, Samir P, Soong L. Brain transcriptomics reveal the activation of neuroinflammation pathways during acute Orientia tsutsugamushi infection in mice. Front Immunol 2023; 14:1194881. [PMID: 37426673 PMCID: PMC10326051 DOI: 10.3389/fimmu.2023.1194881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 09/03/2023] Open
Abstract
Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi (Ot), is prevalent in endemic areas with one million new cases annually. Clinical observations suggest central nervous system (CNS) involvement in severe scrub typhus cases. Acute encephalitis syndrome (AES) associated with Ot infection is a major public health problem; however, the underlying mechanisms of neurological disorder remain poorly understood. By using a well-established murine model of severe scrub typhus and brain RNA-seq, we studied the brain transcriptome dynamics and identified the activated neuroinflammation pathways. Our data indicated a strong enrichment of several immune signaling and inflammation-related pathways at the onset of disease and prior to host death. The strongest upregulation of expression included genes involved in interferon (IFN) responses, defense response to bacteria, immunoglobulin-mediated immunity, IL-6/JAK-STAT signaling, and TNF signaling via NF-κB. We also found a significant increase in the expression of core genes related to blood-brain barrier (BBB) disruption and dysregulation in severe Ot infection. Brain tissue immunostaining and in vitro infection of microglia revealed microglial activation and proinflammatory cytokine production, suggesting a crucial role of microglia in neuroinflammation during scrub typhus. This study provides new insights into neuroinflammation in scrub typhus, highlighting the impact of excessive IFN responses, microglial activation, and BBB dysregulation on disease pathogenesis.
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Affiliation(s)
- Yuejin Liang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
| | - Aditi
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Florence Onyoni
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Hui Wang
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Casey Gonzales
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Piyanate Sunyakumthorn
- Department of Veterinary Medicine, United States Army Medical Directorate, Armed Forces Research Institute of Medical Sciences (United States MD-AFRIMS), Bangkok, Thailand
| | - Ping Wu
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, United States
| | - Parimal Samir
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
| | - Lynn Soong
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
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Kim J, Seok H, Jeon JH, Choi WS, Seo GH, Park DW. Association of scrub typhus with incidence of dementia: a nationwide population-based cohort study in Korea. BMC Infect Dis 2023; 23:127. [PMID: 36859244 PMCID: PMC9976677 DOI: 10.1186/s12879-023-08107-0] [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] [Received: 09/07/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Scrub typhus is a mite-borne infectious rickettsial disease that can occur in rural and urban areas, with an especially high prevalence in older populations. This disease causes systemic vasculitis that can invade the central nervous system. Considering these characteristics, here we examined whether scrub typhus was associated with the occurrence of dementia, using large population-based cohort data. METHOD This population-based cohort study enrolled patients aged 60-89 years using data from the Health Insurance Review and Assessment database of South Korea between 2009 and 2018. We defined scrub typhus and dementia using International Classification of Diseases, Tenth Edition diagnostic codes. The control group was stratified according to age and sex at a ratio of 1:5 to the case group in the study population. The index date was set after 90 days beyond the date of the scrub typhus diagnosis, while the observation period was from the time of the index appointment to December 31, 2020. The primary outcome was newly diagnosed dementia. The secondary outcome was dementia classification, such as Alzheimer's disease, vascular dementia, and other. All analyses were conducted by matching age, gender, and comorbidity. RESULTS During the observation period, 10,460 of 71,047 (14.7%) people who had a history of scrub typhus versus 42,965 of 355,235 (12.1%) people in the control group, that is, with no history of scrub typhus, were diagnosed with dementia (adjusted hazard ratio, 1.12; 95% confidence interval, 1.10-1.15, p < 0.001). The Kaplan-Meier curves for time to cumulative incidence of dementia showed that the dementia incidence in both groups increased over time, while individuals with a past history of scrub typhus had a higher incidence of dementia than the control group. Second, the risk of Alzheimer's disease was significantly higher among patients with a history of scrub typhus (adjusted hazard ratio, 1.15; 95% confidence interval 1.13-1.18, p < 0.001). CONCLUSION In conclusion, a history of scrub typhus infection in old age is significantly associated with an increase in dementia, especially Alzheimer's disease. Our results suggest that prevention and appropriate treatment of scrub typhus should be emphasized as a dementia prevention measure.
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Affiliation(s)
- Jooyun Kim
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Hyeri Seok
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Ji Hoon Jeon
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Won Suk Choi
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, 60 Hyeoksin-ro, Wonju-si, Gangwon-do, 26465, Republic of Korea.
| | - Dae Won Park
- Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea.
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4
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Sharma D, Kumar S, Sharma A, Kumar R, Kumar R, Kulharia M, Kumar M. Functional assignment to hypothetical proteins in Orientia tsutsugamushistrain Ikeda. Bioinformation 2022; 18:188-195. [PMID: 36518125 PMCID: PMC9722422 DOI: 10.6026/97320630018188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 09/19/2023] Open
Abstract
Orientia tsutsugamushi(O. tsutsugamushi) is an intracellular bacterial pathogen which causes zoonosis scrub typhus in humans. Genome of O. tsutsugamushi strain Ikeda contains 214 hypothetical proteins (HPs) which is nearly 20% of the total proteins. Domain and family based functional analysis of HPs results in the annotation of 44 hypothetical proteins. The annotated HPs were classified in to five main classes namely, gene expression and regulation, transport, metabolism, cell signaling and proteolysis. Thus, computational analysis of HPs helps to understand their putative roles in various biological and cellular processes, including pathogenesis for further consideration as potential therapeutic targets.
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Affiliation(s)
- Dixit Sharma
- Department of Animal Sciences, School of Life Sciences, Central University of Himachal Pradesh, District Kangra, Himachal Pradesh, India - 176206
| | - Sunil Kumar
- Department of Animal Sciences, School of Life Sciences, Central University of Himachal Pradesh, District Kangra, Himachal Pradesh, India - 176206
| | - Ankita Sharma
- Centre for Computational Biology and Bioinformatics, School of Life Sciences, Central University of Himachal Pradesh, District Kangra, Himachal Pradesh, India - 176206
| | - Rakesh Kumar
- Department of Animal Sciences, School of Life Sciences, Central University of Himachal Pradesh, District Kangra, Himachal Pradesh, India - 176206
| | - Ranjit Kumar
- Department of Animal Sciences, School of Life Sciences, Central University of Himachal Pradesh, District Kangra, Himachal Pradesh, India - 176206
| | - Mahesh Kulharia
- Centre for Computational Biology and Bioinformatics, School of Life Sciences, Central University of Himachal Pradesh, District Kangra, Himachal Pradesh, India - 176206
| | - Manish Kumar
- Department of Chemistry and Chemical Sciences, School of Physical and Material Science, Central University of Himachal Pradesh, District Kangra, Himachal Pradesh, India - 176206
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Vidyasagar S, Sukumar C, Bolanthakodi N, Lakhmani L, Singh A. Unraveling scrub encephalitis: A study on the clinical profile and investigations of scrub encephalitis. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_110_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]
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Kaur P, Jain R, Kumar P, Randev S, Guglani V. Clinical Spectrum and Outcome of Acute Encephalitis Syndrome in Children with Scrub Typhus: A Series of Eight Cases from India. Indian J Crit Care Med 2020; 24:885-887. [PMID: 33132580 PMCID: PMC7584842 DOI: 10.5005/jp-journals-10071-23590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Scrub typhus has reemerged with a different geographical distribution and varied clinical presentation like acute encephalitis syndrome (AES), which is a less known entity in scrub typhus. In this case series, we studied the clinical profile and outcome of eight patients who presented with AES and a positive scrub serology without any other identifiable cause of encephalopathy. All these patients had fever, altered sensorium, and nuchal rigidity, while seizures were present in six (75%) patients and papilledema in two (25%) patients. Complications like shock, pulmonary edema, and gastrointestinal (GI) bleed were observed in three (37%) patients. All patients except for one responded well to the treatment and recovered completely. Scrub typhus should be suspected early in patients presenting with AES. How to cite this article: Kaur P, Jain R, Kumar P, Randev S, Guglani V. Clinical Spectrum and Outcome of Acute Encephalitis Syndrome in Children with Scrub Typhus: A Series of Eight Cases from India. Indian J Crit Care Med 2020;24(9):885-887.
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Affiliation(s)
- Parminder Kaur
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Reena Jain
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Pankaj Kumar
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Shivani Randev
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Vishal Guglani
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
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7
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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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8
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Garg D, Dhamija RK. Opsoclonus in Scrub Typhus. Ann Indian Acad Neurol 2020; 23:367. [PMID: 32606536 PMCID: PMC7313607 DOI: 10.4103/aian.aian_230_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Effectiveness of Presumptive Treatment of Acute Febrile Illness With Doxycycline or Azithromycin in Preventing Acute Encephalitis Syndrome in Gorakhpur, India: A Cohort Study. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1889-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Sharma D, Sharma A, Singh B, Verma SK. Bioinformatic Exploration of Metal-Binding Proteome of Zoonotic Pathogen Orientia tsutsugamushi. Front Genet 2019; 10:797. [PMID: 31608099 PMCID: PMC6769048 DOI: 10.3389/fgene.2019.00797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
Metal ions are involved in many essential biological processes and are crucial for the survival of all organisms. Identification of metal-binding proteins (MBPs) of human affecting pathogens may provide the blueprint for understanding biological metal usage and their putative roles in pathogenesis. This study is focused on the analysis of MBPs from Orientia tsutsugamushi (Ott), a causal agent of scrub typhus in humans. A total of 321 proteins were predicted as putative MBPs, based on sequence search and three-dimensional structure analysis. Majority of proteins could bind with magnesium, and the order of metal binding was Mg > Ca > Zn > Mn > Fe > Cd > Ni > Co > Cu, respectively. The predicted MBPs were functionally classified into nine broad classes. Among them, gene expression and regulation, metabolism, cell signaling, and transport classes were dominant. It was noted that the putative MBPs were localized in all subcellular compartments of Ott, but majorly found in the cytoplasm. Additionally, it was revealed that out of 321 predicted MBPs 245 proteins were putative bacterial toxins and among them, 98 proteins were nonhomologous to human proteome. Sixty putative MBPs showed the ability to interact with drug or drug-like molecules, which indicate that they may be used as broad-spectrum drug targets. These predicted MBPs from Ott could play vital role(s) in various cellular activities and virulence, hence may serve as plausible therapeutic targets to design metal-based drugs to curtail its infection.
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Affiliation(s)
- Dixit Sharma
- Centre for Computational Biology and Bioinformatics, School of Life Sciences, Central University of Himachal Pradesh, Kangra, India
| | - Ankita Sharma
- Centre for Computational Biology and Bioinformatics, School of Life Sciences, Central University of Himachal Pradesh, Kangra, India
| | - Birbal Singh
- ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, India
| | - Shailender Kumar Verma
- Centre for Computational Biology and Bioinformatics, School of Life Sciences, Central University of Himachal Pradesh, Kangra, India
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Abstract
Scrub typhus is caused by Orientia tsutsugamushi characterized by focal or disseminated vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen and central nervous system. It was thought to have been eradicated from India. Recently it is being reported from many areas of India. The clinical picture and severity of the symptoms varies widely. The neurological manifestations of scrub typhus are not uncommon but are diverse. Meningoencephalitis is classical manifestation of scrub typhus but cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, neuroleptic malignant syndrome and Guillan-Barré syndrome are other manifestations reported in literature. The availability of literature on the neurological manifestations of scrub typhus is limited to case reports mainly. This article reviews various neurological manifestations of scrub typhus reported in literature.
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Affiliation(s)
- Sanjay K Mahajan
- Department of Medicine, I.G. Medical College, Shimla, Himachal Pradesh, India
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12
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Sharma D, Sharma A, Verma SK, Singh B. Targeting metabolic pathways proteins of Orientia tsutsugamushi using combined hierarchical approach to combat scrub typhus. J Mol Recognit 2018; 32:e2766. [DOI: 10.1002/jmr.2766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/04/2018] [Accepted: 09/15/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Dixit Sharma
- Centre for Computational Biology and Bioinformatics, School of Life Sciences; Central University of Himachal Pradesh; Shahpur, District-Kangra Himachal Pradesh India
| | - Ankita Sharma
- Centre for Computational Biology and Bioinformatics, School of Life Sciences; Central University of Himachal Pradesh; Shahpur, District-Kangra Himachal Pradesh India
| | - Shailender Kumar Verma
- Centre for Computational Biology and Bioinformatics, School of Life Sciences; Central University of Himachal Pradesh; Shahpur, District-Kangra Himachal Pradesh India
| | - Birbal Singh
- ICAR-Indian Veterinary Research Institute, Regional Station; Palampur Himachal Pradesh India
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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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Valappil AV, Thiruvoth S, Peedikayil JM, Raghunath P, Thekkedath M. Differential diagnosis of scrub typhus meningitis from tuberculous meningitis using clinical and laboratory features. Clin Neurol Neurosurg 2017; 163:76-80. [PMID: 29078126 DOI: 10.1016/j.clineuro.2017.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The involvement of the central nervous system in the form of meningitis or meningoencephalitis is common in scrub typhus and is an important differential diagnosis of other lymphocytic meningitis like tuberculous meningitis (TBM). The aim of this study was to identify the clinical and laboratory parameters that may be helpful in differentiating scrub typhus meningitis from TBM. PATIENTS AND METHODS We compared of the clinical and laboratory features of 57 patients admitted with scrub typhus meningitis or TBM during a 3-year period. Patients who had abnormal cerebrospinal fluid (CSF) and positive scrub typhus enzyme-linked immunosorbent assay serology (n=28) were included in the scrub typhus meningitis group, while the TBM group included those who satisfied the consensus diagnostic criteria of TBM (n=29). RESULTS Compared with the TBM group, the mean duration of symptoms was less in patients with scrub typhus meningitis, who also had a lower magnitude of neurological deficits, such as altered mental status and cranial nerve and motor deficits. Patients with scrub typhus meningitis had a lower CSF white blood-cell count (WBC) than the TBM group (130.8±213 195±175 cells/mm3, P=0.002), lower CSF protein elevation (125±120 vs. 195.2±108.2mg/dl, P=0.002), and higher CSF sugar (70.1±32.4 vs. 48.7±23.4mg/dl, P=0.006). Features predictive of the diagnosis of scrub typhus meningitis included the absence of neurological impairment at presentation, blood serum glutamic-oxaloacetic transaminase>40 international units (IU)/L, serum glutamic-pyruvic transaminase>60 IU/L, total blood leukocyte count>10,000/mm3, CSF protein<100mg/dl, CSF sugar>50mg/dl, CSF WBC<100 cells/mm3. All patients with scrub typhus meningitis recovered completely following doxycycline therapy CONCLUSIONS: This study suggests that, clinical features, including duration of fever, neurological deficits at presentation and laboratory parameters such as CSF pleocytosis,CSF protein elevation, CSF sugar levels and liver enzyme values are helpful in differentiating scrub typhus meningitis from tuberculous meningits. These features with scrub IgM serology may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.
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Affiliation(s)
- Ashraf V Valappil
- Department of Neurology, Malabar Institute of Medical Sciences, Calicut, Kerala, India.
| | - Sohanlal Thiruvoth
- Department of Microbiology, Malabar Institute of Medical Sciences, Calicut, Kerala, India
| | - Jabir M Peedikayil
- Department of Internal Medicine, Malabar Institute of Medical Sciences, Calicut, Kerala, India
| | | | - Manojan Thekkedath
- Department of Internal Medicine, Malabar Institute of Medical Sciences, Calicut, Kerala, 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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Dhanapriya J, Dineshkumar T, Sakthirajan R, Murugan S, Jayaprakash V, Balasubramaniyan T, Gopalakrishnan N. Scrub typhus meningitis in a renal transplant recipient. Indian J Nephrol 2017; 27:151-153. [PMID: 28356672 PMCID: PMC5358160 DOI: 10.4103/0971-4065.181883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Scrub typhus is a rickettsial infection commonly seen in Asia. The clinical presentation ranges from nonspecific febrile illness to potentially fatal multiorgan involvement such as liver, kidney, or lung. Central nervous system involvement is uncommon. We report a 45-year-old female renal transplant recipient who presented with fever, headache, meningeal signs, graft dysfunction, and eschar. IgM antibodies against Orientia tsutsugamushi were positive by enzyme-linked immunosorbent assay. Despite oral doxycycline therapy for 5 days, she did not improve but responded well to intravenous azithromycin. To the best of our knowledge, scrub typhus as a cause of meningitis in a renal transplant recipient has not been reported so far.
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Affiliation(s)
- J Dhanapriya
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - T Dineshkumar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - R Sakthirajan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - S Murugan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - V Jayaprakash
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - T Balasubramaniyan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - N Gopalakrishnan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
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Rana A, Mahajan SK, Sharma A, Sharma S, Verma BS, Sharma A. Neurological manifestations of scrub typhus in adults. Trop Doct 2016; 47:22-25. [PMID: 27059055 DOI: 10.1177/0049475516636543] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In order to study the neurological manifestations in adult patients suffering from scrub typhus, 323 patients aged over 18 years, admitted with a positive diagnosis, were screened for neurological dysfunction; 37 patients with symptoms and/or signs suggestive of neurological dysfunction were included in the study. Of these, 31 (84%) patients had altered sensorium, four (11%) had cerebellitis, one (2%) patient had acute transverse myelitis and one (2%) had bilateral papilloedema without focal neurological deficit. Of the 31 patients with altered sensorium, 15 (40%) had meningoencephalitis, three (8%) had seizures, two (5%) had cerebral haemorrhages, one (2%) had a presentation likened to neuroleptic malignant syndrome (NMS) and one (2%) had a 6th nerve palsy with inflammation of the right cavernous sinus. Cerebrospinal fluid (CSF) analysis was abnormal in 23 patients (raised lymphocytes in 68%, raised protein in 80%). All patients improved with anti-rickettsial therapy.
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Affiliation(s)
- Abhinav Rana
- Resident, I.G. Medical College, Shimla, Himachal Pradesh, India
| | - Sanjay K Mahajan
- Associate Professor, I.G. Medical College, Shimla, Himachal Pradesh, India
| | - Arindam Sharma
- Resident, I.G. Medical College, Shimla, Himachal Pradesh, India
| | - Sudhir Sharma
- Department of Neurology, I.G. Medical College, Shimla, Himachal Pradesh, India
| | - Balbir S Verma
- Professor, I.G. Medical College, Shimla, Himachal Pradesh, India
| | - Ashok Sharma
- Professor and Head Department of Medicine, I.G. Medical College, Shimla, Himachal Pradesh, India
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Dittrich S, Rattanavong S, Lee SJ, Panyanivong P, Craig SB, Tulsiani SM, Blacksell SD, Dance DAB, Dubot-Pérès A, Sengduangphachanh A, Phoumin P, Paris DH, Newton PN. Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study. LANCET GLOBAL HEALTH 2015; 3:e104-12. [PMID: 25617190 PMCID: PMC4547322 DOI: 10.1016/s2214-109x(14)70289-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Scrub typhus (caused by Orientia tsutsugamushi), murine typhus (caused by Rickettsia typhi), and leptospirosis are common causes of febrile illness in Asia; meningitis and meningoencephalitis are severe complications. However, scarce data exist for the burden of these pathogens in patients with CNS disease in endemic countries. Laos is representative of vast economically poor rural areas in Asia with little medical information to guide public health policy. We assessed whether these pathogens are important causes of CNS infections in Laos. Methods Between Jan 10, 2003, and Nov 25, 2011, we enrolled 1112 consecutive patients of all ages admitted with CNS symptoms or signs requiring a lumbar puncture at Mahosot Hospital, Vientiane, Laos. Microbiological examinations (culture, PCR, and serology) targeted so-called conventional bacterial infections (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, S suis) and O tsutsugamushi, Rickettsia typhi/Rickettsia spp, and Leptospira spp infections in blood or cerebrospinal fluid (CSF). We analysed and compared causes and clinical and CSF characteristics between patient groups. Findings 1051 (95%) of 1112 patients who presented had CSF available for analysis, of whom 254 (24%) had a CNS infection attributable to a bacterial or fungal pathogen. 90 (35%) of these 254 infections were caused by O tsutsugamushi, R typhi/Rickettsia spp, or Leptospira spp. These pathogens were significantly more frequent than conventional bacterial infections (90/1051 [9%] vs 42/1051 [4%]; p<0·0001) by use of conservative diagnostic definitions. CNS infections had a high mortality (236/876 [27%]), with 18% (13/71) for R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp combined, and 33% (13/39) for conventional bacterial infections (p=0·076). Interpretation Our data suggest that R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp infections are important causes of CNS infections in Laos. Antibiotics, such as tetracyclines, needed for the treatment of murine typhus and scrub typhus, are not routinely advised for empirical treatment of CNS infections. These severely neglected infections represent a potentially large proportion of treatable CNS disease burden across vast endemic areas and need more attention. Funding Wellcome Trust UK.
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Affiliation(s)
- Sabine Dittrich
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sue J Lee
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phonepasith Panyanivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Scott B Craig
- University of the Sunshine Coast, Faculty of Science Health, Education and Engineering, Sippy Downs, Australia; Queensland Health Forensic and Scientific Service, WHO Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Australia
| | - Suhella M Tulsiani
- Queensland Health Forensic and Scientific Service, WHO Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Australia; Copenhagen Centre for Disaster Research Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Stuart D Blacksell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Audrey Dubot-Pérès
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; UMR_D 190 "Emergence des Pathologies Virales", Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, Marseille, France
| | - Amphone Sengduangphachanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Phonelavanh Phoumin
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Daniel H Paris
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK.
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Misra UK, Kalita J, Mani VE. Neurological manifestations of scrub typhus. J Neurol Neurosurg Psychiatry 2015; 86:761-6. [PMID: 25209416 DOI: 10.1136/jnnp-2014-308722] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the neurological manifestations of scrub typhus and correlate their clinical, EEG and MRI findings. METHODS A cross-sectional study over 2 years included patients with scrub typhus diagnosed by solid phase immunochromatographic assay or Weil-Felix test. A detailed clinical evaluation including Glasgow Coma Scale (GCS) was documented. Blood counts, chemistry, ECG, chest radiograph, cerebrospinal fluid (CSF), EEG and cranial MRI were performed. Outcome on discharge and at 1 month were categorised into good and poor based on modified Rankin Scale. RESULTS Thirty-seven patients with ages ranging between 3 and 71 years were included; 51% of whom were females. All patients had fever and myalgia. Thirty-one (84%) patients had impaired consciousness, and six were deeply comatose (GCS score ≤8). Eight patients presented with status epilepticus. MRI revealed meningeal enhancement in only 1/25 (4%) patient and EEG showed generalised slowing in 6/28 (21.4%). Among 31 patients with altered sensorium, CSF studies were conducted on 28. Nineteen patients had meningoencephalitis and 9 encephalopathy, but no significant differences were observed in clinical, laboratory, EEG and MRI findings. All patients responded within 48 h to doxycycline and had good recovery at 1 month. Patients with low GCS score had significantly more focal neurological deficit (r=0.5; p=0.002), longer hospital stay (r=-0.4; p=0.03) and more disability on discharge (r=-0.4; p=0.01). CONCLUSIONS Meningoencephalitis/encephalopathy may be seen in two-third of patients with scrub typhus. Scrub typhus should be included in the differential diagnosis of febrile encephalopathy.
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Affiliation(s)
- U K Misra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - J Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - V E Mani
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
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Sharma SR, Masaraf H, Lynrah KG, Lyngdoh M. Tsutsugamushi Disease (Scrub Typhus) Meningoencephalitis in North Eastern India: A Prospective Study. Ann Med Health Sci Res 2015; 5:163-7. [PMID: 26097756 PMCID: PMC4455004 DOI: 10.4103/2141-9248.157486] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Scrub typhus is rampant in northern, eastern, and southern India. Central nervous system involvement in the form of meningitis or meningoencephalitis is common in scrub typhus. As specific laboratory methods remain inadequate or inaccessible in developing countries, prompt diagnosis is often difficult. Aim: The aim of this study was to characterize neurological complications in scrub typhus from northeastern region of India. Subjects and Methods: We did a prospective study of scrub meningoencephalitis at North Eastern Indira Gandhi Regional Institute of Medical Sciences among patients admitted to hospital between October 2009 and November 2011. The diagnosis was made based on the clinical pictures, presence of an eschar, and a positive Weil–Felix test (WFT) with a titer of >1:160 and if required a positive scrub IgM enzyme-linked immunosorbent assay. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits, and magnetic resonance imaging (MRI) brain performed if needed. Results: Twenty-three patients of scrub typhus meningitis that were serologically confirmed were included in the study. There were 13 males and 10 females. Fever ≥1 week was the most common manifestation (39.1%). Interestingly, none had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 17 cells/μL, 90%, 86 mg/dL, 0.6605 and 3.6 U/mL, respectively. All patients were treated with doxycycline. There was no mortality in our study. Conclusions: Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic tuberculous meningitis so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of lymphocytic meningoencephalitis. Delay in treatment can be potentially fatal. WFT still serves as a useful and affordable diagnostic tool for this disease in resource-poor countries.
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Affiliation(s)
- S R Sharma
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - H Masaraf
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - K G Lynrah
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - M Lyngdoh
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Infektionen. NEUROINTENSIV 2015. [PMCID: PMC7175474 DOI: 10.1007/978-3-662-46500-4_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In diesem Kapitel werden zunächst die für die Neurointensivmedizin wesentlichen bakteriellen Infektionen (Meningitis, spinale und Hirnabszesse, Spondylodiszitis, septisch-embolische Herdenzephalitis) abgehandelt, die trotz gezielt eingesetzter Antibiotika und neurochirurgischer Therapieoptionen noch mit einer erheblichen Morbidität und Mortalität behaftet sind. Besonderheiten wie neurovaskuläre Komplikationen, die Tuberkulose des Nervensystems, Neuroborreliose, Neurosyphilis und opportunistische Infektionen bei Immunsuppressionszuständen finden hierbei besondere Berücksichtigung. Der zweite Teil dieses Kapitels behandelt akute und chronische Virusinfektionen des ZNS sowie in einem gesonderten Abschnitt die HIVInfektion und HIV-assoziierte Krankheitsbilder sowie Parasitosen und Pilzinfektionen, die in Industrieländern seit Einführung der HAART bei HIV zwar eher seltener, aber mit zunehmender Globalisierung auch in unseren Breiten immer noch anzutreffen sind.
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Mahajan SK, Kaushik M, Raina R, Sharma RC, Thakur P, Bharat Sharma J. Scrub typhus with visual hallucinations. Trop Doct 2014; 45:146-7. [PMID: 25552462 DOI: 10.1177/0049475514565426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The occurrence of psychiatric symptoms in scrub typhus is not commonly reported in literature. We present a case of scrub typhus with visual hallucinations.
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Affiliation(s)
- Sanjay K Mahajan
- Assistant Professor, Department of Medicine, I. G. Medical College, Shimla, Himachal Pradesh, India
| | - Madan Kaushik
- Assistant Professor, Department of Medicine, I. G. Medical College, Shimla, Himachal Pradesh, India
| | - Rajiv Raina
- Professor, Department of Medicine, I. G. Medical College, Shimla, Himachal Pradesh, India
| | - Ravi C Sharma
- Professor and Head, Department of Psychiatry, I. G. Medical College, Shimla, Himachal Pradesh, India
| | - Preyander Thakur
- Resident, Department of Medicine, I. G. Medical College, Shimla, Himachal Pradesh, India
| | - Jai Bharat Sharma
- Resident, Department of Medicine, I. G. Medical College, Shimla, Himachal Pradesh, India
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Raina S. Syndrome based treatment guidelines for critical tropical infections. Indian J Crit Care Med 2014; 18:761. [PMID: 25425846 PMCID: PMC4238096 DOI: 10.4103/0972-5229.144026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sujeet Raina
- Department of Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
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Agarwal VK, Reddy GKM, Krishna MR, Ramareddy G, Saroj P, Bandaru VCSS. Predictors of scrub typhus: a study from a tertiary care center. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60704-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Griffith M, Peter JV, Karthik G, Ramakrishna K, Prakash JAJ, Kalki RC, Varghese GM, Chrispal A, Pichamuthu K, Iyyadurai R, Abraham OC. Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission. Indian J Crit Care Med 2014; 18:497-502. [PMID: 25136187 PMCID: PMC4134622 DOI: 10.4103/0972-5229.138145] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background and Aims: Scrub typhus, a zoonotic rickettsial infection, is an important reason for intensive care unit (ICU) admission in the Indian subcontinent. We describe the clinical profile, organ dysfunction, and predictors of mortality of severe scrub typhus infection. Materials and Methods: Retrospective study of patients admitted with scrub typhus infection to a tertiary care university affiliated teaching hospital in India during a 21-month period. Results: The cohort (n = 116) aged 40.0 ± 15.2 years (mean ± SD), presented 8.5 ± 4.4 days after symptom onset. Common symptoms included fever (100%), breathlessness (68.5%), and altered mental status (25.5%). Forty-seven (41.6%) patients had an eschar. Admission APACHE-II score was 19.6 ± 8.2. Ninety-one (85.2%) patients had dysfunction of 3 or more organ systems. Respiratory (96.6%) and hematological (86.2%) dysfunction were frequent. Mechanical ventilation was required in 102 (87.9%) patients, of whom 14 (12.1%) were solely managed with non-invasive ventilation. Thirteen patients (11.2%) required dialysis. Duration of hospital stay was 10.7 ± 9.7 days. Actual hospital mortality (24.1%) was less than predicted APACHE-II mortality (36%; 95% Confidence interval 32-41). APACHE-II score and duration of fever were independently associated with mortality on logistic regression analysis. Conclusions: In this cohort of severe scrub typhus infection with multi-organ dysfunction, survival was good despite high severity of illness scores. APACHE-II score and duration of fever independently predicted mortality.
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Affiliation(s)
- Mathew Griffith
- Department of Internal Medicine, University of Colorado, Colorada, USA
| | - John Victor Peter
- Department of Critical Care, Associate Professor, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Gunasekaran Karthik
- Department of Critical Care, Registrar, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Kartik Ramakrishna
- Department of Critical Care, Registrar, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | - Rajamanickam C Kalki
- Department of Critical Care, Registrar, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anugragh Chrispal
- Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Kishore Pichamuthu
- Department of Critical Care, Associate Professor, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Ramya Iyyadurai
- Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Kar A, Dhanaraj M, Dedeepiya D, Harikrishna K. Acute encephalitis syndrome following scrub typhus infection. Indian J Crit Care Med 2014; 18:453-5. [PMID: 25097358 PMCID: PMC4118511 DOI: 10.4103/0972-5229.136074] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Ayan Kar
- Department of General Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - M Dhanaraj
- Institute of Neurosciences, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - Devaprasad Dedeepiya
- Institute of Critical Care Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - K Harikrishna
- Department of General Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India
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Wei Y, Huang Y, Luo L, Xiao X, Liu L, Yang Z. Rapid increase of scrub typhus: an epidemiology and spatial-temporal cluster analysis in Guangzhou City, Southern China, 2006-2012. PLoS One 2014; 9:e101976. [PMID: 25006820 PMCID: PMC4090214 DOI: 10.1371/journal.pone.0101976] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/13/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Scrub typhus has been increasingly reported in Southern China, and public health authorities are concerned about its increased incidence. Additionally, little evidence is available on the epidemiology of scrub typhus in Southern China. This study aims to analyze the epidemiological and geographic features of ST in Guangzhou City, Southern China, to guide the future prevention efforts. METHODS Scrub typhus surveillance data in Guangzhou City during 2006-2012 were obtained from the Chinese National Communicable Disease Surveillance Network. We first conducted a descriptive analysis to analyze the epidemiological features of scrub typhus. Then we used space-time scan statistic based on a discrete Poisson model to detect and evaluate high-risk spatial-temporal clusters of scrub typhus. RESULTS There were 4,001 cases of scrub typhus in Guangzhou City during the study period. The incidence of scrub typhus increased from 3.29 per 100,000 in 2006 to 9.85 per 100,000 in 2012. A summer peak was observed in June and July with a second peak in September and October except year 2009 and 2011. The majority of the cases (71.4%) were among persons aged ≥40 years, and female incidence was higher than male incidence in persons ≥50 years. In the space-time analysis, high-risk clusters were concentrated in rural areas in Guangzhou City. Over the past 7 years, Haizhu District, an urban area, was found to be a high-risk cluster for the first time in 2012. CONCLUSION The resurgence of scrub typhus epidemics in Guangzhou population in 2012 necessitates more effective measures for minimizing future epidemics. Consideration of high-risk population and historical spatial-temporal clusters may help prevent scrub typhus. The risk of scrub typhus in urban areas should not be neglected and needs more attention from public health authorities.
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Affiliation(s)
- Yuehong Wei
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Yong Huang
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Lei Luo
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Xincai Xiao
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Lan Liu
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
- * E-mail:
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28
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Boorugu H, Chrispal A, Gopinath KG, Chandy S, Prakash JJ, Abraham AM, Abraham OC, Thomas K. Central nervous system involvement in scrub typhus. Trop Doct 2013; 44:36-7. [PMID: 24226290 DOI: 10.1177/0049475513512646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Scrub typhus is an emerging infectious disease in India. Among its protean clinical manifestations, central nervous system involvement is common. In this prospective observational study, altered sensorium, headache, seizures and aseptic meningitis were found to be common central nervous system manifestations. Prompt treatment with doxycycline reduces morbidity and mortality.
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Affiliation(s)
- Harikishan Boorugu
- Assistant Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
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29
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Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in South India--a retrospective study. PLoS One 2013; 8:e66595. [PMID: 23799119 PMCID: PMC3682970 DOI: 10.1371/journal.pone.0066595] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/08/2013] [Indexed: 12/13/2022] Open
Abstract
Background Scrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reports Methods A retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness- a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits. Results Sixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol. Conclusion Meningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.
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Affiliation(s)
- Stalin Viswanathan
- Department of General Medicine, Indira Gandhi Medical College, Kathirkamam, Pondicherry, India.
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30
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Saifudheen K, Kumar KGS, 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. [PMID: 22566732 PMCID: PMC3345595 DOI: 10.4103/0972-2327.95002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/13/2011] [Accepted: 03/08/2011] [Indexed: 11/26/2022] Open
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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Affiliation(s)
- K Saifudheen
- Department of Neurology, Medical College, Calicut, Kerala, India
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31
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Infektionen. NEUROINTENSIV 2012. [PMCID: PMC7123678 DOI: 10.1007/978-3-642-16911-3_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trotz Weiterentwicklung moderner Antibiotika in den letzten Jahren sind die Letalitätszahlen der bakteriellen (eitrigen) Meningitis weiterhin hoch; Überlebende haben häufig neurologische Residuen. Die ungünstigen klinischen Verläufe der bakteriellen Meningitis sind meist Folge intrakranieller Komplikationen, wie z. B. eines generalisierten Hirnödems, einer zerebrovaskulären arteriellen oder venösen Beteiligung oder eines Hydrozephalus.
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