Scrub typhus Meningoencephalitis in Children from a Tertiary Care Centre, Uttarakhand, India

Author(s):

Ritu Rakholia, Vinita Rawat* and Preeti Chaturvedi

Meningoencephalitis, a potentially fatal complication of scrub typhus is known to occur but has not been well documented in children. Objectives: To document the epidemiological, clinical and laboratory parameters of scrub typhus meningoencephalitis in children to help the clinician in clinching the diagnosis of scrub typhus infection from Kumaon region. Materials and methods: This is a prospective one year study (June 2015 to July 2016) in which epidemiological, clinical, laboratory profile and detail of cerebrospinal fluid (CSF) analysis and outcome of the scrub typhus meningoencephalitis cases were recorded. Diagnosis of scrub typhus was confirmed by positive IgM Enzyme Linked Immune Sorbent assay (ELISA), IgM Immuno Fluorescence Assay (IFA) and/ or by nested polymerase chain reaction (PCR). Results: A total of 13 children (<18years) presenting with fever, headache and neck rigidity were confirmed as scrub typhus meningoencephalitis during post monsoon season. Myalgia, facial suffusion, seizures, altered sensorium and eschar were found in 84%, 46%, 23%, 30.1% and 15.4% of patients, respectively. Renal, respiratory and gastrointestinal (GIT) involvements were observed in 46%, 61.54%, and 75% of patients respectively. Splenomegaly was seen in 7(53.8%) of patients. Thrombocytopenia (92.3%) and raised transaminase (100%) along with CSF lymphocytosis (100%) were consistent findings. Mean CSF protein, cells and sugar were 80 mg/dl, 27cells/cumm and 63.8 mg/dl respectively. All patients had received azithromycin or doxycyclineand outcome was favorable. Conclusion: In hilly areas scrub typhus should be considered as one of the differential diagnosis in children with suspected aseptic meningoencephalitis, especially when accompanied with raised transaminase level and thrombocytopenia.