Abhilash Kundavaram Paul Prabhakar, Gunasekaran Karthik, Mitra Shubhanker, Patole Shalom, Sathyendra Sowmya, Jasmine Sudha, Varghese G M
Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Neurol India. 2015 Mar-Apr;63(2):209-14. doi: 10.4103/0028-3886.156282.
Central nervous system (CNS) involvement in scrub typhus is seen in up to a quarter of patients. However, the literature on cerebrospinal fluid (CSF) analysis and outcome in meningitis/meningo-encephalitis due to scrub typhus is scant.
This retrospective study included patients who were admitted to a medical college hospital with scrub typhus meningitis/meningo-encephalitis between 2005 and 2011. The clinical and laboratory profile, details of CSF analysis and outcome were documented.
The study included 189 patients with meningitis/meningo-encephalitis due to scrub typhus. The mean age of the patients was 41 ± 4 years. The mean duration of fever before presentation was 9.4 ± 3 days. The common presenting complaints were headache (64.2%), nausea/vomiting (60%), altered sensorium (53.7%) and seizures (22.1%). The presence of an eschar was documented in 27.5% of the patients. The mean CSF white blood count was 80 cells/cu mm (range: 5-740). There was a clear lymphocyte predominance (mean 87.6%). The mean CSF protein level was 105 mg% (range: 13-640). The mean CSF sugar level was 63.9 mg% (range 25-350), and was less than 40 mg% in 11.1% of the cases. The case fatality rate was 5.8% (11/189). Univariate analysis showed the presence of an eschar (15.4% vs 2.2%; Odds Ratio [OR]: 8.1) and altered sensorium (9.8% vs 1.1%; OR: 9.2) to be significant predictors of mortality.
In endemic regions, scrub typhus should be considered in the differential diagnosis of aseptic meningitis. Modest elevation of cells in the CSF with lymphocytic pleocytosis and multi-organ involvement may indicate scrub typhus meningitis/meningo-encephalitis.
高达四分之一的恙虫病患者会出现中枢神经系统（CNS）受累情况。然而，关于恙虫病所致脑膜炎/脑膜脑炎的脑脊液（CSF）分析及预后的文献却很少。
这项回顾性研究纳入了2005年至2011年间因恙虫病脑膜炎/脑膜脑炎入住一所医学院附属医院的患者。记录了临床和实验室资料、CSF分析细节及预后情况。
该研究纳入了189例恙虫病所致脑膜炎/脑膜脑炎患者。患者的平均年龄为41±4岁。就诊前发热的平均持续时间为9.4±3天。常见的就诊主诉为头痛（64.2%）、恶心/呕吐（60%）、意识改变（53.7%）和癫痫发作（22.1%）。27.5%的患者有焦痂记录。CSF白细胞计数平均为80个/立方毫米（范围：5 - 740）。明显以淋巴细胞为主（平均87.6%）。CSF蛋白水平平均为105mg%（范围：13 - 640）。CSF糖水平平均为63.9mg%（范围25 - 350），11.1%的病例低于40mg%。病死率为5.8%（11/189）。单因素分析显示，有焦痂（15.4%对2.2%；优势比[OR]：8.1）和意识改变（9.8%对1.1%；OR：9.2）是死亡的显著预测因素。
在流行地区，无菌性脑膜炎的鉴别诊断应考虑恙虫病。CSF中细胞轻度升高伴淋巴细胞增多及多器官受累可能提示恙虫病脑膜炎/脑膜脑炎。
