Garg Divyani, Manesh Abi
Department of Neurology, Neo Hospital, Noida, Uttar Pradesh, India.
Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Ann Indian Acad Neurol. 2021 Nov-Dec;24(6):849-864. doi: 10.4103/aian.aian_739_21. Epub 2021 Dec 17.
Scrub typhus is one of the most frequent causes of acute febrile illness in South and South-east Asian countries. Neurological features accompany 20% of scrub typhus infections, and may affect the central or peripheral nervous system, and sometime, may even occur in combination. Of late, its recognition among clinicians has increased with widening detection of its cutaneous hallmark, called eschar. Multiple mechanisms underlie neurological involvement, including direct invasion (meningitis, encephalitis), vasculitis (myositis) or immune-mediated mechanisms (opsoclonus, myoclonus, optic neuritis, Guillain-Barre syndrome). Despite an immunological basis for several neurological manifestations, response to doxycycline is remarkable, although immune therapy may be necessary for severe involvement. Scientific literature on scrub typhus neurology chiefly emanates from case reports, case series and small studies, and a comprehensive review is warranted to aid clinicians in recognising neurological involvement. This review aims at enriching this gap, and summarises clinical features, laboratory findings, and treatment options for various neurological facets of scrub typhus.
恙虫病是南亚和东南亚国家急性发热性疾病最常见的病因之一。20%的恙虫病感染伴有神经症状，可累及中枢或周围神经系统，有时甚至两者同时出现。近来，随着对其皮肤特征性表现——焦痂的检测范围扩大，临床医生对该病的认识有所增加。神经受累有多种机制，包括直接侵袭（脑膜炎、脑炎）、血管炎（肌炎）或免疫介导机制（眼阵挛、肌阵挛、视神经炎、吉兰-巴雷综合征）。尽管几种神经表现有免疫学基础，但多西环素治疗效果显著，不过严重受累时可能需要免疫治疗。关于恙虫病神经学的科学文献主要来自病例报告、病例系列和小型研究，因此有必要进行全面综述，以帮助临床医生识别神经受累情况。本综述旨在填补这一空白，总结恙虫病各种神经方面的临床特征、实验室检查结果及治疗选择。
