Objective:

To describe various neurological manifestations observed following scrub typhus infection at our centre, SMS medical college, Jaipur, Rajasthan located in North- western part of India.

Background:

Scrub typhus is a rickettsial illness caused by Orientia tsutsugamushi due to bite of it's larval form. Most cases are seen in a distinct geographical location called the tsutsugamushi triangle extending from Afghanistan to China, Korea, Northen Australia and the islands of Western Pacific and Indian Oceans. In India, scrub typhus has been reported from many states including Himachal Pradesh, Jammu, Rajasthan, Pondicherry and southern states like Andhra Pradesh, Tamil Nadu and Kerala.

Design/Methods:

It is a descriptive observational study where in patients admitted with scrub typhus in SMS medical college and attached hospitals , Jaipur were evaluated for neurological manifestations.These neurological manifestations were due to involvement of central as well as peripheral nervous system and those with multi-axial involvement.The most frequently occuring manifestations in our patients include meningitis, meningo-encephalitis, opsoclonus-myoclonus-ataxia syndrome, cranial neuropathies, Acute disseminated encephalomyelitis (ADEM). The MRI findings in these patients were non specific and some even had normal MRI. a few patients presenting with myoclonus-ataxia syndrome had non specific electroencephalogram ( EEG) changes. two of our patients also presented with intracranial hypertension which is an infrequently reported neurological presentation of scrub typhus and had MRI findings similar to that of idiopathic intracranial hypertension.

Results:

Of the 15 patients that had presented with neurological manifestations following a febrile illness due to scrub typhus, most of the patients had good prognosis and a favourable outcome. Being a reversible inflammatory vascular  endotheliopathy, some patients also had spontaeneous remission of symptoms like myoclonus - ataxia. most of these patients were treated with corticosteroids as an immunomodulatory agent.

Conclusions:

Scrub typhus is an important differential of meningo-encephalitis and also acute onset movement disorders in north western India.