Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India

S crub typhus is an acute febrile illness caused by an obligate intracellular gram-negative bacterium, Orientia tsutsugamushi. It is transmitted through chigger mites and is considered endemic to the tsutsugamushi triangle (covering Asia, northern Australia, and islands in the Indian and Pacific Oceans), although scrub typhus caused by other Orientia species has also been reported in Africa, France, the Middle East, and South America (1). A recent systematic review from hospital-based studies in India reported 25% of acute undifferentiated febrile illness was caused by scrub typhus. Most studies included were from southern India, but only 20% of included patients were <15 years of age (2). Although scrub typhus illness is typically self-limiting, neurologic complications are seen in 20%-25% of patients admitted to the hospital and are associated with high mortality rates (3,4). Scrub typhus can result in myriad neurologic manifestations, including meningitis, meningoencephalitis, encephalopathy, seizures, stroke, neuropathy, optic neuritis, myositis, myelitis, involuntary movements, and Guillain-Barr syndrome, all of which are well recognized in adults