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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.


 

  • References

  • 1 Silpapojakul K, Varachit B, Silpapojakul K. Paediatric scrub typhus in Thailand: a study of 73 confirmed cases. Trans R Soc Trop Med Hyg 2004; 98 (06) 354-359
    CrossrefPubMedGoogle Scholar
  • 2 Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health 2012; 5 (01) 82-88
    CrossrefPubMedGoogle Scholar
  • 3 Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. Indian J Pediatr 2012; 79 (11) 1459-1462
    CrossrefPubMedGoogle Scholar
  • 4 Bhat NK, Dhar M, Mittal G, Chandra H, Rawat A, Chandar V. Scrub typhus: a common rickettsial disease emerging in a new geographical region of north India. J Pediatr Infect Dis 2014; 9: 93-99
    PubMedGoogle Scholar
  • 5 Rathi NB, Rathi AN, Goodman MH, Aghai ZH. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr 2011; 48 (11) 867-872
    CrossrefPubMedGoogle Scholar
  • 6 Kulkarni A, Vaidya S, Kulkarni P, Bidri LH, Padwal S. Rickettsial disease—an experience. Pediatr Infect Dis 2009; 1: 118-124
    PubMedGoogle Scholar
  • 7 Sirisanthana V, Poneprasert B. Scrub typhus in children at Chiang Mai University Hospital. J Infect Dis Antimicrob Agents 1989; 6 (01) 23-27
    PubMedGoogle Scholar
  • 8 Kumar Bhat N, Dhar M, Mittal G. , et al. Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications. Iran J Pediatr 2014; 24 (04) 387-392
    PubMedGoogle Scholar
  • 9 Silpapojakul K. Scrub typhus in the Western Pacific region. Ann Acad Med Singapore 1997; 26 (06) 794-800
    PubMedGoogle Scholar
  • 10 Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India 2010; 58: 24-28
    PubMedGoogle Scholar
  • 11 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 (04) 208-210
    PubMedGoogle Scholar
  • 12 Razak A, Sathyanarayanan V, Prabhu M, Sangar M, Balasubramanian R. Scrub typhus in Southern India: are we doing enough?. Trop Doct 2010; 40 (03) 149-151
    CrossrefPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Isaac R, Varghese GM, Mathai EJ M, Joseph I. Scrub typhus: prevalence and diagnostic issues in rural Southern India. Clin Infect Dis 2004; 39 (09) 1395-1396
    CrossrefPubMedGoogle Scholar
  • 15 Digra SK, Saini GS, Singh V, Sharma SD, Kaul R. Scrub typhus in children in children: Jammu experience. JK Science 2010; 12: 95-97
    PubMedGoogle Scholar
  • 16 Mahajan SK, Rolain JM, Sankhyan N, Kaushal RK, Raoult D. Pediatric scrub typhus in Indian Himalayas. Indian J Pediatr 2008; 75 (09) 947-949
    CrossrefPubMedGoogle Scholar
  • 17 Reller ME, Dumler JS. Scrub typhus (Orientia tsutsugamushi). Kleigman RM, Stanton BF, St Geme JW. , et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier; 2011: 1045-1046
    CrossrefGoogle Scholar
  • 18 Allen AC, Spitz S. A comparative study of the pathology of scrub typhus (Tsutsugamushi disease) and other rickettsial diseases. Am J Pathol 1945; 21 (04) 603-681
    PubMedGoogle Scholar
  • 19 Settle EB, Pinkerton H, Corbett AJ. A pathological study of tsutsugamushi disease (scrub typhus) with notes on clinicopathological correlation. J Lab Clin Med 1945; 30: 639-661
    PubMedGoogle Scholar
  • 20 Pai H, Sohn S, Seong Y, Kee S, Chang WH, Choe KW. Central nervous system involvement in patients with scrub typhus. Clin Infect Dis 1997; 24 (03) 436-440
    CrossrefPubMedGoogle Scholar
  • 21 Varghese GM, Mathew A, Kumar S, Abraham OC, Trowbridge P, Mathai E. Differential diagnosis of scrub typhus meningitis from bacterial meningitis using clinical and laboratory features. Neurol India 2013; 61 (01) 17-20
    CrossrefPubMedGoogle Scholar
  • 22 Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in South India—a retrospective study. PLoS One 2013; 8 (06) e66595
    CrossrefPubMedGoogle Scholar
  • 23 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 (03) 163-167
    CrossrefPubMedGoogle Scholar
  • 24 Scheie HG. Ocular changes associated with scrub typhus: a study of 451 patients. Arch Ophthal 1948; 40 (03) 245-267
    CrossrefPubMedGoogle Scholar
  • 25 Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K. Rickettsial meningitis and encephalitis. Arch Intern Med 1991; 151 (09) 1753-1757
    CrossrefPubMedGoogle Scholar
  • 26 Watt G, Chouriyagune C, Ruangweerayud R. , et al. Scrub typhus infections poorly responsive to antibiotics in northern Thailand. Lancet 1996; 348 (9020): 86-89
    CrossrefPubMedGoogle Scholar
  • 27 Watt G, Kantipong P, Jongsakul K, Watcharapichat P, Phulsuksombati D, Strickman D. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet 2000; 356 (9235): 1057-1061
    CrossrefPubMedGoogle Scholar
  • 28 Lochary ME, Lockhart PB, Williams Jr WT. Doxycycline and staining of permanent teeth. Pediatr Infect Dis J 1998; 17 (05) 429-431
    CrossrefPubMedGoogle Scholar
  • 29 Crum JW, Hanchalay S, Eamsila C. New paper enzyme-linked immunosorbent technique compared with microimmunofluorescence for detection of human serum antibodies to Rickettsia tsutsugamushi . J Clin Microbiol 1980; 11 (06) 584-588
    CrossrefPubMedGoogle Scholar
  • 30 Coleman RE, Sangkasuwan V, Suwanabun N. , et al. Comparative evaluation of selected diagnostic assays for the detection of IgG and IgM antibody to Orientia tsutsugamushi in Thailand. Am J Trop Med Hyg 2002; 67 (05) 497-503
    CrossrefPubMedGoogle Scholar
  • 31 Kingston HWF, Blacksell SD, Tanganuchitcharnchai A. , et al. Comparative Accuracy of the InBios Scrub Typhus Detect IgM Rapid Test for the detection of IgM antibodies by using conventional serology. Clin Vaccine Immunol 2015; 22 (10) 1130-1132
    CrossrefPubMedGoogle Scholar