Neurological Manifestations Of Scrub Typhus: Clinical Spectrum, Neuroimaging Findings, And Predictors Of Adverse Neurological Outcomes In Hospitalized Patients

Abstract

Background. Scrub Typhus is an increasing zoonotic disease caused by the mite-borne organism Orientiam tsutsugamushi, which is prevalent in both India and other countries in Asia and affects the central nervous system in many cases. However, the relationship between the clinical characteristics, neuroimaging findings and neurological outcomes in hospitalized patients is not yet well defined. This study aims to see the neurological involvement in scrub typhus patients who were hospitalized concerning their clinical presentation, imaging findings and adverse outcomes.

Methods. Over a two-year period, an observational prospective study was conducted in the Department of General Medicine at Sudha Medical College and Bharat Vikas Institute of Medical Sciences, Kota. A total of 50 patients with laboratory-confirmed scrub typhus were recruited using non-probability consecutive sampling. The demographic, clinical, neurological as well as laboratory data were acquired from a patient interview, clinical observations as well as hospital documents, and MRI findings, when clinically required and available, were documented. Discharge status was complete recovery, residual disabilities or death. All the data were descriptively analyzed with the statistical software Microsoft Excel using frequencies and percentages.

Results. Neurological symptoms were revealed in 30 of 50 patients (60%). The most common neurologic symptom was unconsciousness (10 patients, 20%), followed by meningitis (7, 14%), seizure (6, 12%), cerebellar disorders (4, 8%) and peripheral neuropathy (3, 6%). Of those 30 patients, 21 (70%) had MRI abnormalities, the majority being meningeal enhancement (9 patients), followed by brain edema (5), white matter pathology (4) and brain stem/cerebellar pathology (3), with nine patients having a normal MRI scan. At the moment of discharge, 38 patients (76%) have completely recovered, 8 (16%) were left with some neurological deficits, and 4 (8%) died.

Conclusion. Scrub typhus can lead to serious neurological diseases, and clinical evaluation and MRI imaging yield useful information although a normal MRI does not rule out a neurological problem. Assessment of neurological status early, MRI when relevant and conducting a full assessment of neurological function prior to discharge is recommended. Restrictions related to the small sample size do not permit generalization of results and larger multicenter studies with more prolonged follow-ups are required to establish independent predictors of neurological morbidity and mortality.