Emerging Infectious Diseases (Apr 2023)

Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India

  • Tina Damodar,
  • Bhagteshwar Singh,
  • Namratha Prabhu,
  • Srilatha Marate,
  • Vykuntaraju K. Gowda,
  • A.V. Lalitha,
  • Fulton Sebastian Dsouza,
  • Sushma Veeranna Sajjan,
  • Mallesh Kariyappa,
  • Uddhava V. Kinhal,
  • P.V. Prathyusha,
  • Anita Desai,
  • Kandavel Thennarasu,
  • Tom Solomon,
  • Vasanthapuram Ravi,
  • Ravi Yadav

DOI
https://doi.org/10.3201/eid2904.221157
Journal volume & issue
Vol. 29, no. 4
pp. 711 – 722

Abstract

Read online

Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, Orientia tsutsugamushi, including IgM and PCR testing of blood and cerebrospinal fluid (CSF) to grade its association with AES. We diagnosed scrub typhus in 87 (23%) children; of those, association with AES was confirmed in 16 (18%) cases, probable in 55 (63%), and possible in 16 (18%). IgM detection in CSF had a sensitivity of 93% and specificity of 82% compared with PCR. Our findings suggest scrub typhus as an emerging common treatable cause of AES in children in southern India and highlight the importance of routine testing for scrub typhus in diagnostic algorithms. Our results also suggest the potential promise of IgM screening of CSF for diagnosis of AES resulting from scrub typhus.

Keywords