Neurological manifestations of scrub typhus: encephalitis and Guillain-Barré syndrome (GBS)

Scrub typhus is a tropical febrile illness that mainly affects rural populations in tropical and subtropical countries. It can range in severity from a mild febrile illness to multisystem involvement. Systemic dysfunction often appears in the second week of sickness, and hepatic, renal and brain inv...

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Published inBMJ case reports Vol. 16; no. 3; p. e253350
Main Authors Modi, Tanish, Sood, Tina, Moudgil, Sandeep, Arora, Navneet
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 29.03.2023
Subjects
Antibiotics
Antibodies
Case reports
Cerebrospinal fluid
Diagnostic tests
Doxycycline - therapeutic use
Encephalitis
Encephalitis - complications
Fever
Guillain-Barre syndrome
Guillain-Barre Syndrome - complications
Guillain-Barre Syndrome - etiology
Humans
Illnesses
Immunoglobulins, Intravenous
Infections
Malaria
Male
Meningitis
Nervous system
Orientia tsutsugamushi
Scrub Typhus - complications
Scrub Typhus - diagnosis
Scrub Typhus - drug therapy
Tropical diseases
Typhus
Velocity
Neurology
Intensive care
Infectious diseases
Tropical medicine (infectious disease)
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Summary:Scrub typhus is a tropical febrile illness that mainly affects rural populations in tropical and subtropical countries. It can range in severity from a mild febrile illness to multisystem involvement. Systemic dysfunction often appears in the second week of sickness, and hepatic, renal and brain involvement are well documented. Although encephalitis is the most frequent neurological ailment, a wide range of unusual complications involving the central and peripheral nervous systems have been identified-however, concomitant multiaxial involvement of the central and peripheral nervous systems is unique. We report a case of a young man with serologically confirmed scrub typhus presenting with fever, eschar, altered sensorium and progressive quadriplegia with hyporeflexic deep tendon reflexes. MRI revealed changes suggestive of encephalitis, and there was evidence of axonopathy on nerve conduction studies. A diagnosis of scrub typhus encephalitis with concomitant Guillain-Barré syndrome was made. He received doxycycline and intravenous immunoglobulin therapy, in addition to supportive treatment.
Bibliography:ObjectType-Case Study-2
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2022-253350