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Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India. 2023
Tina Damodar, and
Bhagteshwar Singh, and
Namratha Prabhu, and
Srilatha Marate, and
Vykuntaraju K Gowda, and
A V Lalitha, and
Fulton Sebastian Dsouza, and
Sushma Veeranna Sajjan, and
Mallesh Kariyappa, and
Uddhava V Kinhal, and
P V Prathyusha, and
Anita Desai, and
Kandavel Thennarasu, and
Tom Solomon, and
Vasanthapuram Ravi, and
Ravi Yadav
Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, Orientia tsutsugamushi, including IgM and PCR testing of blood and cerebrospinal fluid (CSF) to grade its association with AES. We diagnosed scrub typhus in 87 (23%) children; of those, association with AES was confirmed in 16 (18%) cases, probable in 55 (63%), and possible in 16 (18%). IgM detection in CSF had a sensitivity of 93% and specificity of 82% compared with PCR. Our findings suggest scrub typhus as an emerging common treatable cause of AES in children in southern India and highlight the importance of routine testing for scrub typhus in diagnostic algorithms. Our results also suggest the potential promise of IgM screening of CSF for diagnosis of AES resulting from scrub typhus.
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