Table 1.
Clinical characteristics and laboratory findings of patients with O. tsutsugamushi-associated meningitis and encephalitis
| Patient number | Age | Sex | Symptom onset to admission (days) | CNS symptom | Meningeal irritation sign | Associated symptom | Blood tests | CSF profiles | Brain MRI | EEG | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WBC (×109/L) | AST/ALT (units/L) | Total Ab titer | WBC (/µL) | Protein (g/L) | Glucose (mmol/L) | |||||||||
| 1 | 29 | F | 3 | M, HA | + | Fever | 8.9 | 20/8 | 1:160 | 324 | 0.72 | 4.0 | WNL | NA |
| 2 | 47 | M | 4 | ME, HA, confusion, seizure, stupor | + | Fever, eschar | 11.4 | 131/32 | 1:40 | 333 | 0.72 | 4.0 | Leptomeningeal enhancement | Generalized semirhythmic slow waves |
| 3 | 14 | M | 22 | ME, SE, drowsiness, confusion, seizure | − | Fever, skin rash, eschar | 10.3 | 125/111 | 1:2560 | 6 | 0.98 | 5.4 | WNL | Generalized rhythmic slow waves |
| 4 | 38 | M | 6 | M, HA | + | Fever | 4.7 | 81/111 | 1:160 | 20 | 0.42 | 2.3 | WNL | NA |
| 5 | 32 | M | 7 | M, HA, dizziness | + | – | 11.1 | 16/20 | 1:40 | 15 | 0.39 | 2.2 | WNL | WNL |
| 6 | 52 | F | 3 | M, HA | − | Fever, Myalgia | 7.29 | 184/260 | 1:1280 | 14 | 0.57 | 3.2 | Leptomeningeal enhancement | WNL |
| 7 | 27 | M | 13 | M, HA | + | Fever, Skin rash | 8.1 | 22/17 | 1:40 | 675 | 0.96 | 5.3 | WNL | WNL |
| 8 | 40 | F | 9 | ME, HA, dysarthria, limb ataxia, nystagmus | + | Fever | 10.8 | 51/61 | 1:80 | 40 | 0.57 | 3.2 | Leptomeningeal enhancement | Diffuse irregular slowing |
| 9 | 49 | M | 14 | ME, seizure, stupor | − | Fever, AKI, eschar | 6.2 | 75/57 | 1:40 | 1 | 0.41 | 2.3 | WNL | Diffuse irregular slowing |
| 10 | 53 | F | 10 | ME, seizure | − | – | 6.9 | 35/71 | 1:80 | 0 | 0.25 | 1.4 | T2 high signal in right midbrain | WNL |
| 11 | 31 | F | 3 | M | − | Fever, skin rash, vomiting | 7.2 | 21/12 | 1:40 | 360 | 0.63 | 3.5 | Leptomeningeal enhancement | WNL |
| 12 | 23 | F | 22 | M, HA | − | Fever | 4.3 | 39/32 | 1:160 | 180 | 0.64 | 3.6 | WNL | WNL |
| 13 | 72 | F | 12 | M, HA, multiple cr. neuropathy | − | Fever | 4.92 | 17/16 | 1:160 | 120 | 2.46 | 13.7 | Left facial nerve enhancement | NA |
| 14 | 24 | F | 1 | M, HA | − | – | 6.87 | 12/6 | 1:160 | 1,224 | 0.15 | 0.8 | WNL | WNL |
| 15 | 57 | F | 8 | ME, HA, confusion, dysarthria, seizure, stupor | − | Fever | 11.58 | 24/22 | 1:160 | 25 | 0.49 | 2.7 | WNL | Diffuse irregular slowing |
| 16 | 33 | F | 6 | M, HA | − | Fever | 5.45 | 15/5 | 1:80 | 910 | 3.47 | 19.3 | WNL | WNL |
CNS = central nervous system; M = meningitis; ME = meningoencephalitis; HA = headache; SE = status epilepticus; cr. = cranial; AKI = acute kidney injury; AST = aspartate transaminase; ALT = alanine transaminase; Ab = antibody; CSF = cerebrospinal fluid; MRI = magnetic resonance image; EEG = electroencephalography; WNL = within normal limit; NA = not available.