Abstract
Many Rickettsia species are causing human diseases in areas of the world where rickettsioses were previously not investigated in depth. Scrub typhus is a zoonotic disease caused by Orientiatsutsugamushi characterized by focal or disseminated vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen and central nervous system. A 70year old female presented with complaints of fever, myalgia, cough and breathlessness of 1week duration. She had tachycardia, bilateral crepitations with hypoxia. ABG and Chest X ray showed ARDS with sinus tachycardia and elevated troponin I suggestive of myocarditis. Patient was started on piperacillin tazobactam, doxycycline, steroids and other measures. Patient was improving symptomatically but during inpatient stay developed masked facies, rigidity in all limbs with cogwheel rigidity. She was symptomatically managed with tab benzhexol and was discharged. During the regular follow up after a week, patient was noted to have been relieved of the parkinsonism features. She was noted to have amnesia of the period from admission, and the hospital stay. She was positive for Ig M Scrub Elisa. The neurological manifestations of scrub typhus are not uncommon but are diverse. These include meningoencephalitis with focal neurological deficits, cranial nerve palsies, neuroleptic malignant syndrome and Guillain-Barré syndrome. We are presenting this case as our patient has two very uncommon neurological manifestations of scrub typhus namely transient parkinsonism and amnesia in addition to ARDS and myocarditis.
Keywords: scrub typhus, transient parkinsonism, amnesia, ARDS, myocarditis.
References
- Walker DH. Rickettsiae and rickettsial infections: the current state of knowledge. Clin Infect Dis. 2007;45(Suppl 1):S39–S44. doi: 10.1086/518145.
- Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K. Rickettsial meningitis and encephalitis. Arch Intern Med. 1991; 151:1753–1757. doi: 10.1001/archinte.1991.00400090051010.
- Kim DE, Lee SH, Park KI, Chang KH, Roh JK. Scrub typhus encephalomyelitis with prominent focal neurologic signs. Arch Neurol. 2000; 57:1770–1772. doi: 10.1001/archneur.57.12.1770.
- Gulati S, Maheshwari A. Neurological manifestations of scrub typhus. Ann Indian Acad Neurol. 2013; 16:131. doi: 10.4103/0972-2327.107701.Jensenius M, Fournier P, Raoult D. Rickettsioses and the international traveler. Clin Infect Dis. 2004;34:1493–9.
- Haeman Jang, David A. Boltz, and Richard Jay Smeyne. Viral Parkinsonism.1016/j.bbadis.2008.08.001
- Chiou YH, Yang CJ, Lai TH. Scrub typhus associated with transient Parkinsonism and myoclonus. J Clin Neurosci. 2013;2:182–183. doi: 10.1016/j.jocn.2012.01.047.
- Ranjan Premaratna, S. H. Nuwan Chamara Wijayalath, and H. Janaka de Silva. Scrub typhus mimicking Parkinson’s disease. doi.org/10.1186/s13104-015-1428-x
- Yum KS, Na SJ, Lee KO, Ko JH. Scrub typhus meningo-encephalitis with focal neurologic signs and associated brain MRI abnormal findings: literature review. Clin Neurol Neurosurg. 2011; 113:250–253. doi: 10.1016/j.clineuro.2010.11.007.
- Herbert S. Ripley. Neuropsychiatric Observations on Tsutsugamushi Fever (scrub Typhus). Arch Nueropsych 1946;56(1): 42-54. doi:10:1001/archneurpsych.1946.02300180052004
- Kularatne SAM, Edirisingha JS, Gawarammana IB, Urakami H, Chenchittikul M, Kaiho I. Emerging rickettsial infections in Sri Lanka: the pattern in the hilly Central Province. Trop Med Int Health. 2003; 8:803–11.
- Kim DE, Lee SH, Park KI, Chang KH, Roh JK. Scrub typhus encephalomyelitis with prominent focal neurologic signs. Arch Neurol. 2000; 57:1770–1772. doi: 10.1001/archneur.57.12.1770.
Corresponding Author
Dr Kamalasanan. C.G
Additional Professor, Dept of Internal Medicine, Government Medical College, Calicut, 673008, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.15
