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1.
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Scrub Typhus Meningitis or Meningoencephalitis
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
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.