Scrub Typhus Involving Central Nervous System, India, 2004–2006

To the Editor: Scrub typhus, caused by Orientia tsutsugamushi, is one of the most common infectious diseases of rural southern Asia, southeastern Asia, and the western Pacifi c. The disease is transmitted to humans by the bite of larvae of trombiculid mites harboring the pathogen. The disease often appears as a nonspecifi c febrile illness. The clinical picture of scrub typhus is typically associated with fever, rash, myalgia, and diffuse lymphadenopathy (1). Immuno-fl uorescence assay (IFA) is the test of choice for serodiagnosis of rickettsial diseases (2). Scrub typhus has been reported from northern, eastern, and southern India, and its presence has been documented in at least 11 Indian states (3–7). Our study's goal was to retrospectively analyze data of patients with scrub typhus involving the central nervous system. Scrub typhus was suspected on the basis of clinical signs such as febrile illness or fever with rash or eschar. The fever workup pro-fi le (Widal agglutination test, peripheral smear, blood, and urine culture) was noncontributory. Blood samples were obtained after patients gave informed consent. All patients with clinically suspected scrub typhus received Table. Clinical features and laboratory investigations of patients who had scrub typhus with central nervous system involvement, Fever duration before admission, d † 12 12 9 16 Chills + + + Rigors + + + Headache + + + Myalgia + + + + Abdominal pain + + Seizure + + Altered sensorium + + + + Conjunctival suffusion + + + Jaundice + + + + Eschar + Axilla Lymphadenopathy + Generalized + Cervical + Cervical Meningeal signs + + + + Urea, mg/dL 104 96 84 143 Creatinine, mg/dL 3.