**Author details**

CSF analysis in scrub typhus meningoencephalitis reveals mild-to-moderate elevation in protein, low-to-normal glucose and mild degree of lymphocytic pleocytosis. By using nested PCR, the genotypes invading the central nervous system (CNS) may be identified. By this, it was suggested that the Karp and Boryong genotypes possibly invade the CNS more than other types [4]. In the author's study, tuberculous meningitis remained the close differential diagnosis of scrub typhus meningitis due to similar CSF findings [6]. However, CSF adenosine deaminase (ADA) may be helpful, as it is elevated >10 in tuberculous meningitis, unlike scrub typhus meningitis. Neurological involvement in scrub typhus is usually associated with a normal MRI and nonspecific EEG slowing. Often MRI of brain in scrub typhus may reveal features of ischemic

Doxycycline is the drug of choice. It is bacteriostatic to *O. tsutsugamushi* but does not cross the blood brain barrier beyond 15–30% [2]. Therefore, in some instances, neurological deterioration can continue despite doxycycline therapy. This may be due to resistance, immune-mediated injury, or due to drug interactions with oral antacids. Doxycycline is given in the dose of 200 mg/day, in two divided doses, for individuals above 45 kgs body weight, for a duration of 7 days. In children, doxycycline is given in the dose of 4.5 mg/kg body weight in two divided doses. Doxycycline is contraindicated in pregnant women. In complicated cases, intravenous

Azithromycin is another drug which can be used in a dose of 500 mg daily for 5 days and 10 mg/kg body weight in children for 5 days. It can also be given intravenously in complicated cases. Azithromycin is the drug of choice in pregnant women with scrub typhus. It is also preferred in

In complicated cases, Chloramphenicol can also be used. It is administered intravenously at a dose of 50–100 mg/kg/day, 6 hourly doses, followed by oral therapy to complete 7–15 days

Doxycycline and/or chloramphenicol resistant strains have been detected in South-East Asia.

Patients with meningoencephalitis due to scrub typhus can be additionally administered with

Pre-antibiotic era mortality was more than 60%; however, recent data show a mortality of approximately 30% [2]. In the author's study [6], the mortality was 15.38%. Mortality is usu-

Neurological complication is not uncommon in scrub typhus. They present with acute febrile illness with altered sensorium and meningeal signs. The presence of 'eschar' helps in early

dexamethasone, or mannitol, if they have altered sensorium or cranial nerve deficits.

changes due to vasculitis or parainfectious demyelination [5].

66 Meningoencephalitis - Disease Which Requires Optimal Approach in Emergency Manner

is given followed by oral doxycycline to complete 7–15 days of therapy.

patients of scrub typhus with renal failure, where doxycycline is not given.

**2.5. Treatment**

of therapy.

**3. Conclusion**

These strains are sensitive to Azithromycin.

Recovery is usually brisk with appropriate therapy.

ally associated with multi-organ dysfunction syndrome.
