Volume 29, Number 4—April 2023
Synopsis
Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India
, Bhagteshwar Singh, Namratha Prabhu1, Srilatha Marate1, 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, and Ravi Yadav
Table 5
Clinical findings of children with scrub typhus manifesting as acute encephalitis syndrome, southern India
| Clinical features, n = 86* | No. (%) patients |
|---|---|
| Duration of illness, d | |
| <5 | 38 (44) |
| >5 |
48 (56) |
| Clinical signs and symptoms | |
| Fever | 87 (100) |
| Change in mental status† | 87 (100) |
| Seizure | 53 (61.6) |
| Vomiting | 46 (53.5) |
| Headache | 32 (37.2) |
| New abnormal speech (e.g., slurred) including the inability to speak | 24 (27.9) |
| Change in personality or behavior | 18 (20.9) |
| Limb weakness | 11 (12.8) |
| Arthralgia or myalgia | 7 (8.1) |
| Respiratory symptoms‡ | 8 (9.3) |
| Gastrointestinal symptoms§ | 29 (33.7) |
| Urinary symptoms: decreased urine output, burning micturition |
3 (3.5) |
| General and systemic examination findings | |
| Pallor | 23 (26.7) |
| Icterus | 6 (7) |
| Lymphadenopathy: cervical, inguinal, axillary, mesenteric | 16 (18.6) |
| Edema: periorbital, facial, lower limbs, upper limbs | 17 (19.8) |
| Conjunctivitis/subconjunctival hemorrhage | 17 (19.8) |
| Skin rash | 12 (14) |
| Eschar: axilla, groin, dorsal aspect of penis | 4 (4.7) |
| Abnormal bleeding: nasal, anal, gums | 3 (3.5) |
| Respiratory system findings¶ | 21 (24.4) |
| Gastrointestinal system findings# | 50 (58.1) |
| Cardiac system abnormalities: abnormal heart sounds, abnormal pulse |
4 (4.7) |
| Neurologic findings | |
| Cranial nerve abnormality: 6th and 7th | 5 (5.7)** |
| Sign of meningeal irritation: nuchal rigidity, Kernig’s sign, Brudzinski sign, bulging of anterior fontanelle in infants | 41 (47.7) |
| Photophobia | 8 (9.3) |
| Papilledema | 17 (19.8) |
| Abnormal tone | 43 (50) |
| Paresis/paralysis: decreased power in >1 limbs | 16 (18.6) |
| Exaggerated reflexes | 4 (4.7) |
| Abnormal Plantar reflex | 21 (24.4) |
| Involuntary movements†† | 8 (9.3) |
| Cerebellar sign(s)‡‡ | 18 (20.9) |
*All 87 children had fever and change in mental status, but detailed clinical findings of just 86 children were recorded. †Change in mental status was defined as >1 of the following: change in cognition (such as confusion or disorientation), drowsiness, coma, lethargy, irritability, reduced activity, poor feeding, irrelevant/abnormal talk. ‡Includes cough and/or difficulty breathing. Both were present in 5 patients each. §Includes >1 of the following symptoms: abdominal pain, abdominal distension, and diarrhea. Individually, abdominal pain was a symptom in 19 (22%), abdominal distention in 12 (14%), and diarrhea in 3 (3.5%) patients. ¶Signs of respiratory distress occurred in 16 (19%) patients; reduced air entry or abnormal respiratory sounds occurred in 5 (5%) patients. #Hepatomegaly was present in 47 (54.7%) patients, splenomegaly was present in 16 (18.6%) patients, and ascites was present in 4 (4.7%) patients. **Four persons had abnormalities in 6th cranial nerve, and 1 in 7th cranial nerve. ††Opsoclonus and myoclonus, choreoathetoid movements and hemiballismus, abnormal perioral movements, lip smacking, teeth grinding, and rapid eye blinking occurred in 1 patient each; tremors occurred in 2 patients. ‡‡Includes >1 of the following: truncal ataxia, gait abnormality, finger-nose incoordination, nystagmus, dysdiadochokinesis, and dysarthria.
1These authors contributed equally to this article.