Department of General Medicine, Indira Gandhi Medical College, Kathirkamam, Pondicherry, India.
PLoS One. 2013 Jun 14;8(6):e66595. doi: 10.1371/journal.pone.0066595. Print 2013.
Scrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reports.
A retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness--a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits.
Sixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol.
Meningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.
尽管没有确切的统计数据，但印度流行恙虫病。20 年前仅有一项关于恙虫病性脑膜炎的研究。大多数关于恙虫病性脑膜炎/脑膜脑炎的报告都是病例报告。
在本地治里进行了一项回顾性研究，以提取 2011 年 2 月至 2012 年 1 月期间住院的恙虫病患者。诊断是通过以下任何一种方法在患有急性发热疾病的患者中组合得出的 - 刮痕 IgM ELISA、 Weil-Felix 试验和焦痂阳性。有头痛、颈项强直、意识改变或颅神经缺损的患者进行腰椎穿刺。
发现 65 例恙虫病病例，其中 17 例（17/65）患有脑膜炎。有 33 名男性和 32 名女性。有 13 例焦痂。中位数脑脊液（CSF）细胞计数、淋巴细胞百分比、CSF 蛋白、CSF 葡萄糖/血糖、CSF ADA 分别为 54 个/µL、98%、88mg/dL、0.622 和 3.5U/mL。改变意识和颅神经缺损的患者计算机断层扫描正常。患有脑膜炎的患者呼吸症状和体征较少，尿素水平较高。除了一名患者另外接受氯霉素治疗外，所有患者均接受多西环素治疗。
恙虫病性脑膜炎较轻，恢复迅速且完全。临床特征和 CSF 发现可模仿结核性脑膜炎，除 ADA 水平外。在印度，恙虫病和结核病都流行的情况下，ADA 和刮痕 IgM 可能有助于识别患有恙虫病性脑膜炎的患者，并避免在淋巴细胞性脑膜炎病例中进行长期经验性抗结核治疗。
