| Particulars |
Case 1 |
Case 2 |
Case 3 |
| Age and gender |
52 years, female |
19 years, female |
47 years, female |
| Presenting complaints |
Fever, myalgia, and altered sensorium |
Fever, vomiting, lower extremity edema, altered sensorium |
Fever, shortness of breath, altered sensorium |
| Eschar |
Absent |
Absent |
Absent |
| Travel history |
Not any |
Not any |
Not any |
| Vaccination history |
Unavailable |
Fully vaccinated per the national immunization schedule |
Unavailable |
| Resident of (height above sea level) |
Gulmi district, Nepal (610-3050 m) |
Arghakhachi district, Nepal (302-2515 m) |
Gulmi district, Nepal (610-3050 m) |
| Duration of symptoms at presentation to the hospital |
5 days |
10 days |
12 days |
| Neurologic findings |
Neck rigidity - present |
Neck rigidity - present |
Neck rigidity - absent |
| Bilateral plantar reflex-flexor response |
Bilateral Plantar reflex - extensor response |
Bilateral plantar reflex - extensor response |
| Right-sided facial (upper and lower) weakness and incomprehensible speech |
No facial weakness and normal speech |
No facial weakness and normal speech |
| Fundoscopic findings |
No papilledema |
No papilledema |
No papilledema |
| Other findings |
Pallor |
Pallor |
Tachycardia |
| Hepatosplenomegaly |
Icterus |
Hypotension |
| |
Hepatosplenomegaly |
|
| Treatment and response |
Oral Doxycycline for 5 days |
Oral doxycycline for 5 days |
IV Doxycycline for 5 days |
| Resolution of symptoms in 3 days |
Resolution of symptoms in 5 days |
Resolution of symptoms in 5 days |
