Table. Clinical features and laboratory investigations of patients who had scrub typhus with central nervous system involvement, India, 2004–2006*.
| Clinical and laboratory features |
Results |
|||
|---|---|---|---|---|
| Patient 1 |
Patient 2 |
Patient 3 |
Patient 4 |
|
| Age, y/sex | 52/M | 50/F | 30/F | 47/F |
| Date of hospital admission | 2004 Aug 22 | 2004 Aug 30 | 2005 Sep 9 | 2005 Sep 15 |
| 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 |
3.9 |
1.5 |
1.6 |
2.7 |
| Bilirubin, mg/dL | ||||
| Total | 3.5 | 2.7 | 4.6 | 3.0 |
| Conjugated |
1.0 |
1.7 |
3.6 |
2.6 |
| Aspartate aminotransferase, IU | 167 | 160 | 166 | 30 |
| Alanine aminotransferase, IU | 139 | 198 | 185 | 38 |
| Alkaline phosphatase, IU | 80 | 1,000 | 1,000 | 782 |
| Proteinuria, mg/dL |
+ |
− |
+ |
+ |
| CSF cytology |
Lymphocytes,
54 cells/mm3 |
Lymphocytes,
14 cells/mm3 |
Lymphocytes,
60 cells/mm3 |
Neutrophils,
38 cells/mm3 |
| Protein, mg/dL | 125 | 69 | 34 | 118 |
| Glucose, mg/dL |
34 |
44 |
33 |
48 |
| IFA titers‡ | ||||
| IgG | 512 | 512 | Not done | Not done |
| IgM |
<64 |
<64 |
|
|
| Drug treatment | Azithromycin, doxycycline | Ceftriaxone, doxycycline | Ceftriaxone, doxycycline | Ceftriaxone, doxycycline |
| Outcome | Died | Improved | Improved | Left hospital against advice |
*CSF, cerebrospinal fluid; IFA, immunofluorescence assay; Ig, immunoglobulin. †Fever defined as AM temperature >98.9o F or PM temperature >99.9o F. ‡IFA significant titers: IgG >128; IgM >64. The single serum samples, obtained at admission to hospital, were subjected to IFA by using a panel of 11 rickettsial antigens comprising spotted fever group rickettsiae (Rickettsia japonica, R. helvetica, R. slovaca, R. conorii subsp. indica, R. honeï, R. heilongjangensis, and R. felis), R. typhi, and Orientia tsutsugamushi (Gilliam, Kato, and Kawasaki strains).