Scrub Typhus Meningitis or Meningoencephalitis

Dong-Min Kim Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea

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Jong-Hoon Chung Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea

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Na-Ra Yun Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea

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Seok Won Kim Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea

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Jun-Young Lee Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea

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Mi Ah Han Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea

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Yong-Bok Lee Departments of Internal Medicine, Neurosurgery, Orthopedic Surgery, and Preventive Medicine, School of Medicine, Chosun University, Gwangj, Republic of Korea; College of Pharmacy, Institute of Bioequivalence and Bridging Study, Gwangj, Republic of Korea

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Orientia tsutsugamushi induces vasculitis leading to symptoms of systemic organ invasion including meningitis and meningoencephalitis. We conducted a retrospective case-control study of scrub typhus patients to investigate the clinical and laboratory features of patients with scrub typhus meningitis or meningoencephalitis, and the therapeutic outcomes, and to determine the predictor factors. Cases were 22 patients with scrub typhus meningitis or meningoencephalitis, and controls were 303 patients without meningitis or meningoencephalitis. Multivariate analysis showed that the presence of pneumonitis was associated with the occurrence of scrub typhus meningitis and meningoencephalitis (odds ratio [OR] 8.9; P < 0.001; confidence interval [CI] 2.9–27.2). Although appropriate antimicrobials such as doxycycline agents were administered at an early stage, meningitis or meningoencephalitis still occurred in some cases. Physicians should be aware that meningitis or meningoencephalitis may develop during appropriate drug therapy such as doxycycline. Close observation and great care are essential for patients with risk factors, particularly pneumonitis.

Author Notes

* Address correspondence to Seok Won Kim, Department of Neurosurgery, School of Medicine, Chosun University, 588, Seosuk-dong, Dong-gu, Gwangju-city, 501-717, Korea. E-mail: chosunns@chosun.ac.kr
† Dong-Min Kim and Jong-Hoon Chung contributed equally to this work.

Financial support: This study was supported by research funds from Chosun University, 2010.

Authors' addresses: Dong-Min Kim, Jong-Hoon Chung, and Na-Ra Yun, Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea, E-mails: drongkim@chosun.ac.kr, jschung@chosun.ac.kr, and shine@chosun.ac.kr. Seok Won Kim, Department of Neurosurgery, School of Medicine, Chosun University, Gwangju, Korea, E-mail: chosunns@chosun.ac.kr. Jun-Young Lee, Department of Orthopaedic Surgery, School of Medicine Chosun University, Gwangju, Republic of Korea, E-mail: leejy88@chosun.ac.kr. Mi Ah Han, Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: mahan@chosun.ac.kr. Yong-Bok Lee, College of Pharmacy, Institute of Bioequivalence and Bridging Study, Chonnam National University, Buk-Ku, Gwangju, E-mail: leeyb@chonnam.chonnam.ac.kr.

Reprint requests: Dong-Min Kim, Division of Infectious Diseases, Department of Internal Medicine, Chosun University School of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, 501-717, Republic of Korea, E-mail: drongkim@chosun.ac.kr.

  • 1.

    Kim SJ, Chung IK, Chung IS, Song DH, Park SH, Kim HS, Lee MH, 2000. The clinical significance of upper gastrointestinal endoscopy in gastrointestinal vasculitis related to scrub typhus. Endoscopy 32: 950955.

    • Search Google Scholar
    • Export Citation
  • 2.

    Ogawa M, Hagiwara T, Kishimoto T, Shiga S, Yoshida Y, Furuya Y, Kaiho I, Ito T, Nemoto H, Yamamoto N, Masukawa K, 2002. Scrub typhus in Japan: epidemiology and clinical features of cases reported in 1998. Am J Trop Med Hyg 67: 162165.

    • Search Google Scholar
    • Export Citation
  • 3.

    Thap LC, Supanaranond W, Treeprasertsuk S, Kitvatanachai S, Chinprasatsak S, Phonrat B, 2002. Septic shock secondary to scrub typhus: characteristics and complications. Southeast Asian J Trop Med Public Health 33: 780786.

    • Search Google Scholar
    • Export Citation
  • 4.

    Elsom KA, Beebe GW, Sayen JJ, Scheie HG, Gammon GD, Wood FC, 1961. Scrub typhus: a follow-up study. Ann Intern Med 55: 784795.

  • 5.

    Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K, 1991. Rickettsial meningitis and encephalitis. Arch Intern Med 151: 17531757.

  • 6.

    Kim DM, Yun NR, Yang TY, Lee JH, Yang JT, Shim SK, Choi EN, Park MY, Lee SH, 2006. Usefulness of nested PCR for the diagnosis of scrub typhus in clinical practice: a prospective study. Am J Trop Med Hyg 75: 542.

    • Search Google Scholar
    • Export Citation
  • 7.

    Kim DM, Kim SW, Choi SH, Yun NR, 2010. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 10: 108.

  • 8.

    Lee J, Kim DM, Yun NR, Byeon YM, Kim YD, Park CG, Kim MW, Han MA, 2011. A comparative study of hepatitis caused by scrub typhus and viral hepatitis A in South Korea. Am J Trop Med Hyg 85: 873877.

    • Search Google Scholar
    • Export Citation
  • 9.

    World Health Organization (WHO), 2004. WHO Recommended Surveillance Standards. Second edition. Available at: http://www.who.int/emcdocuments/surveillance/docs/whocdscsrisr992.pdf. Accessed June 19, 2004.

    • Search Google Scholar
    • Export Citation
  • 10.

    Ko AI, Galvao Reis M, Ribeiro Dourado CM, Johnson WD Jr, Riley LW, 1999. Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet 354: 820825.

    • Search Google Scholar
    • Export Citation
  • 11.

    Yu M, Nardella A, Pechet L, 2000. Screening tests of disseminated intravascular coagulation: guidelines for rapid and specific laboratory diagnosis. Crit Care Med 28: 17771780.

    • Search Google Scholar
    • Export Citation
  • 12.

    Pai H, Sohn S, Seong Y, Kee S, Chang WH, Choe KW, 1997. Central nervous system involvement in patients with scrub typhus. Clin Infect Dis 24: 436440.

    • Search Google Scholar
    • Export Citation
  • 13.

    Vallejo-Maroto I, Garcia-Morillo S, Wittel MB, Stiefel P, Miranda M, Pamies E, Aparicio R, Carneado J, 2002. Aseptic meningitis as a delayed neurologic complication of murine typhus. Clin Microbiol Infect 8: 826827.

    • Search Google Scholar
    • Export Citation
  • 14.

    Dotevall L, Hagberg L, 1989. Penetration of doxycycline into cerebrospinal fluid in patients treated for suspected Lyme neuroborreliosis. Antimicrob Agents Chemother 33: 10781080.

    • Search Google Scholar
    • Export Citation
  • 15.

    Raoult D, Drancourt M, 1991. Antimicrobial therapy of rickettsial diseases. Antimicrob Agents Chemother 35: 24572462.

  • 16.

    Yim CW, Flynn NM, Fitzgerald FT, 1985. Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis. Antimicrob Agents Chemother 28: 347348.

    • Search Google Scholar
    • Export Citation
  • 17.

    Strickman D, Sheer T, Salata K, Hershey J, Dasch G, Kelly D, Kuschner R, 1995. In vitro effectiveness of azithromycin against doxycycline-resistant and - susceptible strains of Rickettsia tsutsugamushi, etiologic agent of scrub typhus. Antimicrob Agents Chemother 39: 24062410.

    • Search Google Scholar
    • Export Citation
  • 18.

    Mindermann T, Zimmerli W, Gratzl O, 1998. Rifampin concentrations in various compartments of the human brain: a novel method for determining drug levels in the cerebral extracellular space. Antimicrob Agents Chemother 42: 26262629.

    • Search Google Scholar
    • Export Citation
  • 19.

    Nau R, Prange HW, Menck S, Kolenda H, Visser K, Seydel JK, 1992. Penetration of rifampicin into the cerebrospinal fluid of adults with uninflamed meninges. J Antimicrob Chemother 29: 719724.

    • Search Google Scholar
    • Export Citation
  • 20.

    Cho BA, Ko Y, Kim YS, Kim S, Choi MS, Kim IS, Kim HR, Cho NH, 2012. Phenotypic characterization of peripheral T cells and their dynamics in scrub typhus patients. PLoS Negl Trop Dis 6: e1789.

    • Search Google Scholar
    • Export Citation
  • 21.

    Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E, 2006. Scrub typhus among hospitalized patients with febrile illness in South India: magnitude and clinical predictors. J Infect 52: 5660.

    • Search Google Scholar
    • Export Citation
  • 22.

    Song SW, Kim KT, Ku YM, Park SH, Kim YS, Lee DG, Yoon SA, Kim YO, 2004. Clinical role of interstitial pneumonia in patients with scrub typhus: a possible marker of disease severity. J Korean Med Sci 19: 668673.

    • Search Google Scholar
    • Export Citation
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