Clinical Profile and Long-Term Outcomes of Scrub Typhus Meningoencephalitis in Children.

INTRODUCTION

Scrub typhus is a significant cause of acute encephalitis syndrome (AES) in pediatric populations, particularly in northern India. Its long-term outcomes have not been well studied to date. This study investigates the clinical profile and long-term outcomes of scrub typhus meningoencephalitis in children.

METHODS

This prospective observational study was conducted at King George's Medical University, Uttar Pradesh, India, from August 2018 to October 2020. Children aged 0.3 months to 14 years who presented with AES were tested for scrub typhus using serum IgM Enzyme-Linked Immunosorbent Assay (ELISA) and polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) and peripheral blood mononuclear cells (PBMC). Positive patients were followed up for one year to assess long-term neurological outcomes.

RESULTS

Of 264 children tested for scrub typhus, 78 (29.5%) were positive. Neurological symptoms included altered sensorium (70 (89.74%)), seizures (69 (88.46%)), and focal neurological deficits 8 (10.26%). Hepato-splenomegaly (27 (34.61%)), thrombocytopenia (48 (61.5%)), and raised liver transaminases (51 (65.4%)) were the other common manifestations. Mortality occurred in 10.25% of cases. Sixty-seven cases were followed up for one year. Long-term outcomes indicated that 60 (89.55%) of the patients fully recovered, while seven (10.45%) experienced sequelae, including minor impairment in four (5.97%), moderate impairment in two (2.99%), and severe impairment in one case (1.49%).

CONCLUSION

Scrub typhus is a major cause of AES in children, with significant neurological sequelae in a small number of cases.