Central Nervous System Infection Associated with Orientia tsutsugamushi in South Korea

Han Sang Lee Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Jun-Sang Sunwoo Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea;

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Seon-Jae Ahn Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Jangsup Moon Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Jung-Ah Lim Department of Neurology, National Center for Mental Health, An affiliate of the Ministry for Health & Welfare, Seoul, South Korea;

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Jin-Sun Jun Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Woo-Jin Lee Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Soon-Tae Lee Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Keun-Hwa Jung Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Kyung-Il Park Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea

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Ki-Young Jung Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Sang Kun Lee Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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Kon Chu Department of Neurology, Seoul National University Hospital, Seoul, South Korea;

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DOI:
https://doi.org/10.4269/ajtmh.17-0077
Volume/Issue:
Volume 97: Issue 4
Page(s):
1094–1098
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Orientia tsutsugamushi is a major cause of vector-borne infection in Asia. Prompt recognition and appropriate treatment are crucial because of its potentially fatal complications and lack of response to beta-lactam antibiotics. The present study retrospectively evaluated the clinical characteristics and laboratory findings of 16 patients with scrub typhus-related central nervous system (CNS) infections. Single titers ≥ 1:40 of total serum antibodies against O. tsutsugamushi detected by an indirect immunofluorescent assay were considered as positive results. The median age was 35.5 (range, 14–72) years, and 10 (62.5%) patients were female. The most common symptoms were headache (81.3%) and fever (81.3%). Eschar formation was found in three (18.8%) patients. Among patients with encephalitis, seizures and altered consciousness occurred in five (83.3%) and four (66.7%) patients, respectively. An abnormal liver function was noted in seven (43.8%) patients. The median antibody titer was 1:120 (range, 1:40–1:2,560). Typical cerebrospinal fluid profiles were lymphocytic pleocytosis, mild protein elevations, and normal glucose levels. All patients received an empirical treatment with doxycycline and most (93.8%) of them recovered without neurological sequelae. None of the patients reported side effects of the doxycycline treatment. An empirical treatment with doxycycline is needed in patients with CNS infections in scrub typhus endemic areas.

Author Notes

Address correspondence to Kon Chu, Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea. E-mail: stemcell.snu@gmail.com

These authors contributed equally to this work.

Financial support: This study was supported by a grant from the Seoul National University Hospital Research Fund (0320150430) and the Soonchunhyang University Research Fund.

Authors’ addresses: Han Sang Lee, Seon-Jae Ahn, Jangsup Moon, Jin-Sun Jun, Woo-Jin Lee, Soon-Tae Lee, Keun-Hwa Jung, Ki-Young Jung, Sang Kun Lee, and Kon Chu, Depertment of Neurology, Seoul National University Hospital, Seoul, South Korea, E-mails: hansanglee1127@gmail.com, ahnsj2000@gmail.com, jangsup.moon@gmail.com, junjinsun0401@gmail.com, eoozin@gmail.com, staelee@gmail.com, jungkh@gmail.com, jungky10@gmail.com, sangkun2923@gmail.com, and stemcell.snu@gmail.com. Jun-Sang Sunwoo, Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea, E-mail: ultrajs4@gmail.com. Jung-Ah Lim, Department of Neurology, National Center for Mental Health, An Affiliate of the Ministry for Health & Welfare, Seoul, South Korea, E-mail: jungah0118@gmail.com. Kyung-Il Park, Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea, E-mail: ideopki@gmail.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2017
Received:
01 Feb 2017
|
Accepted:
16 Jun 2017
|
Published Online:
31 Jul 2017
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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