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R.R.D. reemerging infectious illnesses in the GNE 477 Indian subcontinent. 1 This resurgence in cases of ST is attributed to deforestation, antimicrobial prescription practices, and availability of better diagnostic modalities. 2 The manifestations range from asymptomatic illnesses to severe forms resulting in multiorgan dysfunction syndrome and death. 3 4 Pediatric scrub typhus meningitis/meningoencephalitis (STM) incidence varies from 6 to 30% across various studies published from tropical countries. 5 6 7 8 9 10 11 12 However, none of these studies have tried to detect ST in cerebrospinal fluid (CSF) specimen. Instead, they have used blood immunoglobulin M (IgM) positivity as a surrogate marker of STM in a compatible clinical setting (features of meningitis/encephalitis). The current study attempted to describe the profile and outcome of STM children with and without ST IgM antibody in CSF. Methods This cross-sectional study was spanned over 18 months period (January 2017 to June 2018) in the pediatrics department of a tertiary care teaching hospital from Eastern part of India. Children 14 years of age with GNE 477 acute undifferentiated febrile illness (AUFI) were included. 13 Enrolment of eligible children was done after obtaining consent from parents/legal guardian. Approval of GNE 477 Institute’s Ethics Committee (IMF/04/2016) was obtained before start of the study. Laboratory tests including complete blood count, serum electrolytes, liver, and renal function tests were done in all the patients. Microbiological analysis included blood culture, peripheral smear examination for malaria parasite and malarial antigen detection test, dengue enzyme-linked immunosorbent assay (ELISA) NS1 antigen and IgM capture ELISA, Widal test, and IgM ELISA against em Orientia tsutsugamushi /em (InBios International, Inc., Seattle, Washington, United States). Children having features of meningitis/meningoencephalitis (headache, altered sensorium, neck rigidity, seizure, or focal neurological deficit) underwent CSF analysis. CSF (diluted in 1:10 proportion) of laboratory-confirmed ST cases were Cav1 further tested by ELISA for antibody (IgM) against em Orientia tsutsugamushi /em . Optical density values 1.00 and 0.5 were taken as cutoffs from serum and CSF, respectively. Either doxycycline or azithromycin was used as treatment for duration of 10 days. Statistical Analysis Data were analyzed after entering them into Microsoft Excel spreadsheet followed by application of STATA software version 12.0 (College Station, Texas, United States). Demographic, clinical, and laboratory details were expressed as number (%), mean (standard deviation) or median (interquartile range). Student’s em t /em -test (for normally distributed data) or MannCWhitney U test (for skewed data) was used to analyze continuous data. Fisher’s exact test or chi-squared test was used to analyze categorical data. For identification of factors associated with neurological involvement, univariate analysis was performed. Statistical significance was set at a em p /em -value of 0.05. Results A total of 171 children with undifferentiated fever (AUFI) were admitted, and 76 (44.4%) had positive blood IgM antibody against em Orientia tsutsugamushi /em ( Fig. 1 ). Of them, eight children (10.5%) were found to have meningitis/meningoencephalitis (STM); five (62.5%) children were CSF positive for ST IgM antibodies. The age of included children ranged from 4 to 12 years, and boys were commonly affected (3 times more than girls). Open in a separate window Fig. 1 Flowchart of study children. AUFI, acute undifferentiated febrile illness; CSF, cerebrospinal fluid; IgM, immunoglobulin M. The clinical and laboratory findings, treatment, and outcome details have been described in Tables 1 and ?and2 .2 . All the children recovered with sequelae in one child (right GNE 477 lateral rectus palsy). No child required intensive care unit admission. Table 1 Details (demographic and clinical) of scrub meningitis/meningoencephalitis cases thead th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Characteristics /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 1 /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 2 /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 3 /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 4 /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 5 /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 6 /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 7 /th th align=”left” valign=”bottom” rowspan=”1″ colspan=”1″ Patient 8 /th /thead Age (y)/sex9 / M8 / M4 / M8 / F11 / M9 / M12 / M12 / FFever duration (d)75483745Chills and rigorNoYesYesNoNoNoNoNoOthersNoPain abdomen, vomitingAbdomen distension, vomitingPain abdomen, vomitingVomitingReeling of headPhotophobia, anorexiaDizzinessSeizureYesNoNoNoNoYesNoNoHeadacheNoYesYesNoYesYesNoYesAtaxiaNoNoYesNoNoNoNoNoAltered sensoriumYesNoYesNoYesYesNoYesMeningeal signNoYesYesYesNoYesYesYesTachycardiaNoNoNoNoYesNoNoNoLow BPNoNoNoNoYesNoNoNoTachypneaYesNoYesNoYesNoNoNoRash (nonpruritic)NoYesNoNoNoNoYesNoEscharNoNoNoYesNoNoNoNoPallorNoYesYesNoNoNoYesNoEdemaNoNoYesYesNoNoNoNoIcterusNoNoNoYesNoNoNoNoLymphadenopathyNoNoInguinal nodes (tender)Neck nodesNoNoNoNoHepatomegalyNoYesYesYesNoNoYesYesSplenomegalyNoYesNoNoNoNoYesNo Open in a separate window Abbreviations: BP, blood pressure;.