MRI Brain Findings and Clinical Spectrum of Children With Typhus-Positive Acute Encephalitis Syndrome: Associations With Neurological Sequelae

Background Scrub typhus, caused by Orientia tsutsugamushi through chigger bites, is a significant cause of acute encephalitis syndrome (AES) in children in Southeast Asia. Materials and methods This cross-sectional study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital in Gorakhpur district, Uttar Pradesh, India, over one year, from October 2021 to September 2022. Result Among 274 AES patients screened, 144 (52.55%) tested positive for scrub typhus via enzyme-linked immunosorbent assay (ELISA). Half of the affected patients were aged 1-5 years. MRI abnormalities were found in 29 (27.10%) patients, showing multiple patchy lesions in both cerebral hemispheres, caudate nucleus, basal ganglia, thalamus, and the midbrain. Significant associations were identified between shock (p=0.00001), myocarditis (p=0.002), refractory seizure (p=0.001), respiratory failure (p=0.001), and the development of sequelae (p=0.0003) at discharge. Conclusion Scrub typhus is the leading cause of AES in North India. Abnormal MRI findings have a significant association with complications and sequelae at discharge in AES patients.