A Study of Clinico-radiological, CSF Profile and Outcome of Scrub Typhus Meningoencephalitis with Special Reference to Atypical Presentation

Abstract

Background: Scrub typhus is an endemic disease, which is caused by Orientia tsutsugamushi. Scrub typhus affects a region known as “the
tsutsugamushi triangle”, which starts from the northern part of Japan and extends to the southern part of Northern Australia, northern part of
Russia, and Pakistan. The present study focued to generate evidence regarding clinical manifestation and treatment outcome of the scrub typhus
meningoencephalitis cases admitted in a tertiary care centre of Burdwan, West Bengal.
Materials & Methods: The cross-sectional observational study was done at inpatient department of General Medicine, Burdwan Medical College
& Hospital, Burdwan, West Bengal. The duration of study was 18 months. Diagnosed patients of scrub typhus meningoencephalitis, attending
inpatient (IPD) department of General Medicine were included in study population. Calculated final sample size was 68. Liver function test,
renal function test, coagulation profile, CSF analysis, NCCT brain, MRI brain was done.
Results: Prevalence of serious scrub typhus infection was 68.6%. Nearly 44.3% study subjects were within 18-36 years age group; majority were
male (64.3%). 70% had shown Eschar formation. 44.3% had comorbidities. Nearly 43% study subjects presented with pallor, 38% presented
with icterus, 27.6% with hypotension, 21% with hepatomegaly, 18.4% with splenomegaly and 22% with neck rigidity. Nearly 57.1% study
subjects had bleeding disorder, 37.1% with hepatitis, 25.7% with acute kidney injury and 22.9% with meningitis. Age and Eschar formation had
significant associations with disease severity of study subjects. Coagulation profile (platelet, INR, D-dimer, APTT), serum urea, creatinine, liver
function (bilirubin, SGOT, SGPT, albumin) and total count of WBC, Hemoglobin, CRP and serum ferritin were also significantly associated
with treatment outcome.
Conclusion: Atypical presentations in scrub typhus were common and they were needed to be treated early to reduce morbidity & mortality
burden of the disease.