Unusual Magnetic Resonance Imaging Features of Scrub Typhus Encephalitis.

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The diagnosis of scrub typhus relies on the patient's history of exposure, clinical manifestations, and results of serological tests. Our patient had a history of altered sensorium, inability to walk, and macular rashes predominantly distributed over the chest and bilateral upper limbs. Post serological testing, the patient was referred to the radiology department for MRI brain. Radiologically, MRI being a superior modality helps in the evaluation of lesions in depth, helping to simplify the diagnosis of meningitis, scrub typhus encephalitis, and other related conditions. Various findings have been described in scrub typhus encephalitis in MR brain imaging, and our case shows an unusual finding in brain imaging.

Clinical profile and predictors of severity in paediatric scrub typhus with pulmonary involvement.

Pulmonary involvement is common in children with scrub typhus. Our paper outlines the clinical characteristics of pulmonary involvement and analyses the predictors of its severity. All scrub typhus serology-positive (optical density >0.5) children with pulmonary symptoms were included. Of 506 serology-positive scrub typhus cases, 256 (50.5%) had pulmonary symptoms, of whom 50 (9.8%) were severe. These severe cases were compared with non-severe cases. Interstitial pneumonitis was the commonest chest radiographic finding. Logistic regression analysis identified 'fever clearance time' >48 h, facial puffiness, maculopapular rash and anaemia to be significantly associated with severe pulmonary involvement.

Diffusion tensor imaging analysis in scrub typhus meningoencephalitis to determine the alteration of microstructural subcortical white-matter integrity.

BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI) of the brain in scrub typhus meningoencephalitis is non-specific, and in the majority of the cases, conventional MRI fails to detect any abnormality. However, autopsy reports depict central nervous system involvement in almost all patients. There is therefore a need for research on the quantitative assessment of brain parenchyma that can detect microstructural abnormalities. The study aimed to assess the microstructural integrity changes of scrub typhus meningoencephalitis by using different diffusion tensor imaging (DTI) parameters. METHODS: This was a retrospective analysis of scrub typhus meningoencephalitis. Seven patients and seven age- and sex-matched healthy controls were included. Different DTI parameters such as apparent diffusion coefficient (ADC), fractional anisotropy (FA), relative anisotropy (RA), trace, volume ratio (VR) and geodesic anisotropy (GA) were obtained from six different regions of subcortical white matter at the level of the centrum semiovale. Intergroup significant difference was determined by one-way analysis of variance followed by Tukey's post hoc test. Receiver operating characteristic curves were constructed to determine the accuracy of the DTI matrices. RESULTS: There was a significant decrease in FA, RA and GA as well as an increase in ADC and VR in the subcortical white matter in patients with scrub typhus meningoencephalitis compared to controls (p < 0.001). The maximum sensitivity of the DTI parameters was 85.7%, and the maximum specificity was 81%. CONCLUSION: There was an alteration of subcortical white-matter integrity in scrub typhus meningoencephalitis that represents the axonal degeneration, myelin breakdown and neuronal degeneration. DTI may be a useful tool to detect white-matter abnormalities in scrub typhus meningoencephalitis in clinical practice, particularly in patients with negative conventional MRI.

Cerebellitis as a rare manifestation of scrub typhus fever.

Scrub typhus is a mite-borne rickettsial disease caused by Orientia tsutsugamushi, a gram-negative coccobacilli transmitted through the bite of chigger mite. Scrub typhus has diverse clinical manifestations, often presenting either as a simple febrile illness or as a complicated multi-organ dysfunction. Neurological complications in scrub typhus are diverse but their exact incidence is unknown. Cerebellitis is another rare neurological manifestation associated with scrub typhus. Here, we report the case of a 26-year-old woman with serologically confirmed scrub typhus presenting with fever and gross cerebellar dysfunction. MRI was normal. She was managed with antimicrobials and made an uneventful recovery.

Comparison of chest radiographic findings between severe fever with thrombocytopenia syndrome and scrub typhus: Single center observational cross-sectional study in South Korea.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by SFTS virus (SFTSV) which involves multiple organ systems, including lungs. However, there is limited data on lung involvement of SFTS. Therefore, the present study investigated the chest radiographic findings of SFTS, including computed tomography (CT), and compared these with those of scrub typhus, which is the most common tick-borne illness in South Korea and share risk factors and occur in similar settings.Medical records of patients with confirmed SFTS and scrub typhus in a tertiary hospital in Seoul (South Korea), between January 2014 and June 2018, were reviewed. Initial chest radiography and CT were reviewed by 2 experienced radiologists.A total of 39 patients with SFTS and 101 patients with scrub typhus were analyzed. All patients except 3 patients with scrub typhus in both groups received chest radiography. Cardiomegaly (90%) and patchy consolidation with ground glass opacity (GGO) pattern (31%) were more common in SFTS group than scrub typhus group (20%, P < .001 and 2%, P < .001, respectively). About half of each group received chest CT. Consolidation (29%) and pericardial effusion (24%) were more common in SFTS group than scrub typhus group (6%, P = .02 and 4%, P = .008, respectively). Interstitial thickening in chest radiography (58%) and chest CT (65%) was more frequent in scrub typhus group than SFTS group (18%, P < .001 and 19%, P < .001, respectively).Cardiomegaly with/without pericardial effusion and patchy consolidation with GGO pattern were more frequent in SFTS group, whereas interstitial thickening was more frequent in scrub typhus group. These findings will assist the early differentiation of SFTS from scrub typhus.

Common features of F-18 FDG PET/CT findings in Scrub Typhus: prospective study before and after antibiotics therapy.

Scrub typhus is an acute febrile illness caused by obligate intracellular organism Orientia tsutsugamushi. While there have been many reports on the evaluation of disease activity and infectious diseases using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), the clinical value of FDG PET/CT in scrub typhus has not been fully investigated. We enrolled 17 patients who were 18 years of age or older and clinically suspected of having scrub typhus with eschar. Clinical assessments, blood samples, and FDG PET/CT images were obtained at enrolment and again after 3 weeks. The median age of the patients was 65 years; 9 (52.9%) patients were male. On initial FDG PET/CT, the eschars showed markedly increased FDG uptake on PET imaging that improved after treatment. Generalized lymphadenopathy and splenomegaly with high FDG uptake were observed in all patients. On follow-up FDG PET/CT after appropriate therapy, FDG uptake and sizes of eschar, lymph nodes, and spleen were markedly decreased. As far as we are aware, this is the first investigation with multiple patients of FDG PET/CT in scrub typhus and the demonstration of clinical utility. FDG PET/CT imaging of scrub typhus could provide useful information about the clinical features before and after antibiotic treatment.

Scrub Typhus and Abnormal Electrocardiography.

This study compared the frequency of abnormal electrocardiogram (ECG) types between scrub typhus patient group and age- and gender-matched health checkup group and their associations with disease severity in scrub typhus patient. Demographic characteristics and ECG and laboratory findings of patients with scrub typhus admitted to Chosun University Hospital, and normal subjects visiting the hospital for health checkup from January 2008 to December 2012 were retrospectively studied. Electrocardiogram abnormalities at admission were observed in 72 of 165 (43.6%) scrub typhus confirmed patients. The following ECG abnormalities were observed: arrhythmic group (31 cases, 18.8%), ischemic change group (25 cases, 15.1%), prolonged QT group (32 cases, 19.4%).Compared with the age and gender-matched health checkup group, ECG abnormalities were more commonly observed in scrub typhus patient group (13.9% versus 43.6%, P < 0.001). In addition, when compared with the normal ECG group, scrub typhus in the abnormal ECG group showed greater disease severity and this phenomenon was particularly prominent in the prolonged QT group. Based on our study prolonged QT observed in approximately 20% of patients with scrub typhus, clinicians should pay additional attention to drugs that affect QT interval.

Acute severe monarthritis: a rare manifestation of scrub typhus.

Scrub typhus caused by Orientia tsutsugamushi is an important cause for fever of unknown origin in endemic areas including India. The vasculitis associated with the disease leads to a variety of clinical manifestations. However, the joint involvement is quite rare and not reported in children. We present severe arthritis of hip joint associated with scrub typhus causing a diagnostic and management challenges in a 4-year-old girl.

Anti-aquaporin-4 Antibody Positive Optic Neuritis Following Scrub Typhus in an Elderly Female.

INTRODUCTION: Aquaporin-4 antibody (AQP4-Ab) is specific for neuromyelitis optica spectrum disorder (NMOSD) and so is helpful to distinguish NMOSD from other autoimmune diseases. Several viral infections may play a role in the onset of NMOSD. CASE REPORT: We describe a case of a previous healthy 82-year-old woman who presented with acute visual loss occurring 3 weeks after scrub typhus. Physical examination showed a relatively afferent pupillary defect in the right eye and ophthalmoscopy revealed edema of the right optic disc. Enhanced magnetic resonance imaging revealed enhancement of the right optic nerve. Serological testing showed AQP4-Ab. After methylprednisolone pulse therapy followed by oral tapering of prednisolone, visual dysfunction was improved. Subsequently she experienced no attacks for 5 years. CONCLUSIONS: Optic neuritis (ON) associated with scrub typhus is extremely rare. Our case support that scrub typhus could trigger ON in a lifelong asymptomatic patient with AQP4-Ab and AQP4-Ab should be considered in a very old age patient with suspected postinfectious inflammatory ON.

Prolonged coma in a scrub typhus patient.

Central nervous system symptoms occur in more than 80% of patients with scrub typhus infection; however, the entity of central nervous system involvement is still not fully understood. We present the case of a patient with fulminant scrub typhus with multiple organ failure, including prolonged deep coma, and detail the sequential neurological symptoms, signs, laboratory data, and neuroradiological findings.

Central nervous system lesions in scrub typhus rediscovered: An autopsy report.

While neurological manifestations in scrub typhus have been well described both in clinical and radiological reports in the literature, neuropathological features are rarely reported. They range from subtle "typhus nodules" to more widespread capillaritis. Familiarity with pathological features is essential for correct interpretation. We describe the clinical, imaging, and histological findings in an autopsy case of scrub typhus, which was pre-terminally superimposed by fungal meningoencephalitis. Interestingly, the autopsy revealed morphological evidence of both etiologies.

Scrub typhus: radiological and clinical findings in abdominopelvic involvement.

PURPOSE: To describe the clinical and radiological findings of abdominopelvic involvement in scrub typhus. MATERIALS AND METHODS: Abdominopelvic computed tomography (CT) of 78 patients with scrub typhus were evaluated by two readers. The presence of gallbladder wall thickening, arterial inhomogeneous enhancement of the liver, periportal edema, splenic infarction, hepatomegaly, splenomegaly, ascites, pleural effusion, and sites of lymphadenopathy were evaluated. Patients were divided into four clinical subgroups according to laboratory findings. Association between imaging findings and subgroups was analyzed by Chi squared test or Fisher's exact test. RESULTS: The most common CT finding was hepatomegaly (74.4%), followed by splenomegaly (66.7%). The majority of patients had at least three areas of abdominopelvic lymphadenopathy (71.8%). Pelvic lymphadenopathy was most commonly seen when eschar was found in the ipsilateral lower extremity (left, n = 5/7; right, n = 8/13). Significant association between hepatic dysfunction and perigastric lymphadenopathy was documented (p = 0.03). CONCLUSION: Scrub typhus has a spectrum of variable clinical and radiological findings mimicking those of acute hepatitis. Diffuse abdominopelvic lymphadenopathy involving the retroperitoneum and pelvic area may aid in early diagnosis of scrub typhus. Perigastric lymphadenopathy could be a sign of severe scrub typhus combined with hepatic dysfunction.

Chest radiographic manifestations of scrub typhus.

BACKGROUND AND RATIONALE: Respiratory system involvement in scrub typhus is seen in 20-72% of patients. In endemic areas, good understanding and familiarity with the various radiologic findings of scrub typhus are essential in identifying pulmonary complications. MATERIALS AND METHODS: Patients admitted to a tertiary care center with scrub typhus between October 2012 and September 2013 and had a chest X ray done were included in the analysis. Details and radiographic findings were noted and factors associated with abnormal X-rays were analyzed. RESULTS: The study cohort contained 398 patients. Common presenting complaints included fever (100%), generalized myalgia (83%), headache (65%), dyspnea (54%), cough (24.3%), and altered sensorium (14%). Almost half of the patients (49.4%) had normal chest radiographs. Common radiological pulmonary abnormalities included pleural effusion (14.6%), acute respiratory distress syndrome (14%), airspace opacity (10.5%), reticulonodular opacities (10.3%), peribronchial thickening (5.8%), and pulmonary edema (2%). Cardiomegaly was noted in 3.5% of patients. Breathlessness, presence of an eschar, platelet counts of <20,000 cells/cumm, and total serum bilirubin >2 mg/dL had the highest odds of having an abnormal chest radiograph. Patients with an abnormal chest X-ray had a higher requirement of noninvasive ventilation (odds ratio [OR]: 13.98; 95% confidence interval CI: 5.89-33.16), invasive ventilation (OR: 18.07; 95% CI: 6.42-50.88), inotropes (OR: 8.76; 95% CI: 4.35-17.62), higher involvement of other organ systems, longer duration of hospital stay (3.18 ± 3 vs. 7.27 ± 5.58 days; P< 0.001), and higher mortality (OR: 4.63; 95% CI: 1.54-13.85). CONCLUSION: Almost half of the patients with scrub typhus have abnormal chest radiographs. Chest radiography should be included as part of basic evaluation at presentation in patients with scrub typhus, especially in those with breathlessness, eschar, jaundice, and severe thrombocytopenia.

Imaging of Scrub Typhus by PET/CT.

A 19-year-old man had an unexplained fever, dizziness, headache, fatigue, and pain in the scrotum. An FDG PET/CT imaging was acquired to assess fever of unknown origin. The images showed multiple foci of increased FDG activity in the enlarged lymph nodes in the body. In addition, mildly increased activity in the enlarged spleen and lung bases was also noted. The patient was eventually diagnosed with scrub typhus based on positive results of the Weil-Felix agglutination test, eschar in the scrotum, and effective therapy.

18F-FDG PET/CT Findings of Scrub Typhus.

Scrub typhus is an acute infectious disease caused by Orienta tsutsugamushi, which is clinically manifested by fever, generalized lymphadenopathy, diffuse myalgia, headache, maculopapular rash, and eschars at the site of chigger feedings. Diagnosis of scrub typhus requires compatible clinical features, history of exposure, and result of selorogic testing. In recent years, F-FDG PET/CT is seen as having increasing potential for use in examination and management of patients with infectious or inflammatory disorders. This is a PET/CT case demonstrating scrub typhus in a patient without evidence of recurrence of thyroid papillary cancer.