Scrub typhus combined with central nervous system infection: four cases report and literatures review

Abstract

Objective To summarize the clinical manifestations, laboratory examination, imaging examination, genetic test, treatment and prognosis of scrub typhus combined with central nervous system (CNS) infection. Methods and Results The clinical data of 4 cases of scrub typhus encephalitis diagnosed and treated from October to November in Tianjin Huanhu Hospital were analyzed. The main clinical manifestations were eschar and lymphadenopathy (4 cases), headache (4 cases), nausea and vomiting (3 cases), fever (3 cases), rash (3 cases), and mental behavior disorder (3 cases); laboratory examination of hepatic in 3 cases were abnormality. Three patients underwent lumbar puncture of cerebral spinal fluid (CSF), including 3 cases with elevated pressure, 2 with elevated white blood cell count, 3 with elevated protein quantification, and 3 with abnormal immune function. Head MRI examination in 3 cases were normal, and one case showed a slightly linear hyperintensity of FLAIR in the bilateral occipital lobes. Metagenomic next⁃generation sequencing (mNGS) of CSF was completed in 3 patients, and Orientia tsutsugamushi was detected in all of them. All 4 cases were diagnosed as scrub typhus encephalitis and recovered after effective antibiotic treatment. Conclusions The clinical manifestations of scrub typhus combined with CNS infection are not specific, so it is necessary to be vigilant against the occurrence of scrub typhus in patients with CNS infection of unknown etiologys. In particular, scrub typhus should be considered during the epidemic season, if there is a history of farm work or suburban activities.

Keywords

• scrub typhus
• central nervous system
• infections
• encephalitis
• metagenome