A case of scrub typhus with meningitis as the onset: Case report and literature review.

Autor:	Zhang BC; Department of Orthopedics, People's Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China., Yang ZB; Department of Orthopedics, People's Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China., Liao RL; Department of Orthopedics, People's Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China., Ma ZQ; Department of Clinical Laboratory, People's Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China., Zhang QJ; Department of Emergency, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China., He QK; Department of Neurology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China., Duan XY; Department of Tuberculosis Diseases, Third People's Hospital of Kunming City, Kunming, China., Liu MW; Department of Emergency, The People's Hospital of Dali Bai Autonomous Prefecture, Dali, Yunnan, China.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2024 Jun 21; Vol. 103 (25), pp. e38613.
DOI:	10.1097/MD.0000000000038613
Abstrakt:	Rationale: Scrub typhus is a naturally occurring acute febrile disease caused by Orientia tsutsugamushi. Although it can cause multiple organ dysfunction, central nervous system infections are uncommon. Patient Concerns: A 17-year-old male presented with a 5-day history of fever and headaches. The MRI of the head revealed thickness and enhancement of the left temporal lobe and tentorium cerebelli, indicating potential inflammation. Diagnoses: The patient was diagnosed with a central nervous system infection. Interventions: Ceftriaxone and acyclovir were administered intravenously to treat the infection, reduce fever, restore acid-base balance, and manage electrolyte disorders. Outcomes: Despite receiving ceftriaxone and acyclovir as infection therapy, there was no improvement. Additional multipathogen metagenomic testing indicated the presence of O tsutsugamushi infection, and an eschar was identified in the left axilla. The diagnosis was changed to scrub typhus with meningitis and the therapy was modified to intravenous doxycycline. Following a 2-day therapy, the body temperature normalized, and the fever subsided. Conclusions: The patient was diagnosed with scrub typhus accompanied by meningitis, and doxycycline treatment was effective. Lession: Rarely reported cases of scrub typhus with meningitis and the lack of identifiable symptoms increase the chance of misdiagnosis or oversight. Patients with central nervous system infections presenting with fever and headache unresponsive to conventional antibacterial and antiviral treatment should be considered for scrub typhus with meningitis. Prompt multipathogen metagenomic testing is recommended to confirm the diagnosis and modify the treatment accordingly. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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