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Volume 16, Number 10—October 2010

Letter

Scrub Typhus Involving Central Nervous System, India, 2004–2006

Sanjay K. MahajanComments to Author , Jean-Marc Rolain, Anil Kanga, and Didier Raoult
Author affiliations: Author affiliations: Indira Gandhi Medical College, Shimla, India (S.K. Mahajan, A. Kanga); Université de la Méditerranée, Marseille, France (J.-M. Rolain, D. Raoult)

Main Article

Table

Clinical features and laboratory investigations of patients who had scrub typhus with central nervous system involvement, India, 2004–2006*

Clinical and laboratory features
Results
Patient 1
Patient 2
Patient 3
Patient 4
Age, y/sex 52/M 50/F 30/F 47/F
Date of hospital admission 2004 Aug 22 2004 Aug 30 2005 Sep 9 2005 Sep 15
Fever duration before admission, d†
12
12
9
16
Chills + + +
Rigors + + +
Headache + + +
Myalgia + + + +
Abdominal pain + +
Seizure + +
Altered sensorium + + + +
Conjunctival suffusion + + +
Jaundice + + + +
Eschar + Axilla
Lymphadenopathy + Generalized + Cervical + Cervical
Meningeal signs
+
+
+
+
Urea, mg/dL 104 96 84 143
Creatinine, mg/dL
3.9
1.5
1.6
2.7
Bilirubin, mg/dL
Total 3.5 2.7 4.6 3.0
Conjugated
1.0
1.7
3.6
2.6
Aspartate aminotransferase, IU 167 160 166 30
Alanine aminotransferase, IU 139 198 185 38
Alkaline phosphatase, IU 80 1,000 1,000 782
Proteinuria, mg/dL
+

+
+
CSF cytology
Lymphocytes,
54 cells/mm3
Lymphocytes,
14 cells/mm3
Lymphocytes,
60 cells/mm3
Neutrophils,
38 cells/mm3
Protein, mg/dL 125 69 34 118
Glucose, mg/dL
34
44
33
48
IFA titers‡
IgG 512 512 Not done Not done
IgM
<64
<64


Drug treatment Azithromycin, doxycycline Ceftriaxone, doxycycline Ceftriaxone, doxycycline Ceftriaxone, doxycycline
Outcome Died Improved Improved Left hospital
against advice

*CSF, cerebrospinal fluid; IFA, immunofluorescence assay; Ig, immunoglobulin.
†Fever defined as AM temperature >98.9o F or PM temperature >99.9o F.
‡IFA significant titers: IgG >128; IgM >64. The single serum samples, obtained at admission to hospital, were subjected to IFA by using a panel of 11 rickettsial antigens comprising spotted fever group rickettsiae (Rickettsia japonica, R. helvetica, R. slovaca, R. conorii subsp. indica, R. honeï, R. heilongjangensis, and R. felis), R. typhi, and Orientia tsutsugamushi (Gilliam, Kato, and Kawasaki strains).

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