Clinico-radiological spectrum of neurological involvement in scrub typhus: insights from 17 cases at a Quaternary Care Centre

Abstract Objective We evaluate the clinical and radiological features, as well as the outcomes, of neurological disorders associated with scrub typhus. Methods This is a retrospective, cross-sectional study from South India, from January 2020 to January 2023. Patients presented with meningoencephalitis, cerebellitis, rhombencephalitis, vasculitis, and opsoclonus myoclonus ataxia syndrome (OMAS). A late complication of polyradiculopathy was also observed. The investigations included cerebrospinal fluid (CSF) examination and magnetic resonance imaging (MRI) brain. Results Seventeen patients with scrub typhus-associated neurological disorders were included, with a mean age of 31.6 ± 13.1 years, and two-thirds were males. The majority of patients had lymphocytic pleocytosis in CSF and raised protein. Brain MRI changes included meningeal enhancement, acute infarcts, and alterations in the brainstem and cerebellum. All patients received doxycycline and the majority showed improvement at follow-up. Conclusion Scrub typhus-associated neurological disorders commonly present as meningitis, encephalitis, or meningoencephalitis, with lymphocytic pleocytosis and raised protein in CSF. We expand the spectrum to include CNS vasculitis- like picture, rhombencephalitis, OMAS and a hitherto unreported late complication of polyradiculopathy. Early diagnosis and prompt treatment with doxycycline and supportive care can lead to favorable outcomes.