A Case of Scrub Typhus Meningoencephalitis without Eschar
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Scrub typhus caused byOrientia tsutsugamushi manifests as fever, headache, myalgia and sometimes central nervous system dysfunction after mite bite. Eschar is an important diagnostic factor for scrub typhus but can be absent in about 30% of cases. We report a 6yearold boy with scrub typhus meningoencephalitis, in whom diagnosis was late due to absence of eschar and direct exposure history. He was transferred to our hospital due to altered mental status and seizures following sustained fever. Previously, he had been diagnosed with aseptic meningitis as cerebrospinal fluid examination showed pleocytosis with normal range of glucose and protein. No pathogen had been proven and no abnormalities had been found in brain magnetic resonance imaging. On admission to our hospital, electroencephalography showed diffuse delta slowing with bilateral frontal sharps and scrub typhus antibody was positive, although the patient had no eschar. Family historytaking revealed his grandmother had been recently treated for scrub typhus and his father helping her farm and often cared for the patient wearing his working pants, as a possible vehicle of infection. Recovery was gradually upon treatment with clarithromycin, intravenous methylprednisolone and immunoglobulin. As scrub typhus can be present without eschar and can be transmitted through contaminated clothes, it needs to be considered for patients presenting with meningoencephalitis in a vulnerable season.
Abstract
Scrub typhus caused byOrientia tsutsugamushi manifests as fever, headache, myalgia and sometimes central nervous system dysfunction after mite bite. Eschar is an important diagnostic factor for scrub typhus but can be absent in about 30% of cases. We report a 6yearold boy with scrub typhus meningoencephalitis, in whom diagnosis was late due to absence of eschar and direct exposure history. He was transferred to our hospital due to altered mental status and seizures following sustained fever. Previously, he had been diagnosed with aseptic meningitis as cerebrospinal fluid examination showed pleocytosis with normal range of glucose and protein. No pathogen had been proven and no abnormalities had been found in brain magnetic resonance imaging. On admission to our hospital, electroencephalography showed diffuse delta slowing with bilateral frontal sharps and scrub typhus antibody was positive, although the patient had no eschar. Family historytaking revealed his grandmother had been recently treated for scrub typhus and his father helping her farm and often cared for the patient wearing his working pants, as a possible vehicle of infection. Recovery was gradually upon treatment with clarithromycin, intravenous methylprednisolone and immunoglobulin. As scrub typhus can be present without eschar and can be transmitted through contaminated clothes, it needs to be considered for patients presenting with meningoencephalitis in a vulnerable season.
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