Rickettsial Meningoencephalitis – An under diagnosed entity in developing countries

Bharath Kumar Reddy, Basavaraja G.V
5.750 1.259

Abstract


Rickettsial infections form a diverse group of infections cause by obligate intracellular coccobacilli. Children less than 15 years are known to be the commonest group affected. The disease which is transmitted by vector such as the tick, mite and flea is divided into 3 biogroups – scrub typhus, typhus and the spotted fever groups. We present the profile of a case series of children diagnosed as rickettsial meningoencephalitis, who were referred to our hospital with a provisional diagnosis of either pyogenic meningitis, viral encephalitis or tubercular meningitis. Of the 122 children admitted with rickettsial fever during the study period, 31% had features of meningoencephalitis. The most common age of presentation was 5 years and above. The common clinical manifestations in these children included fever (100%), headache (100%), maculopapular rash (68.4%), seizures (94.7%) and altered sensorium (89.4%). Investigations revealed polymorphonuclear leucocytosis with relative monocytosis, hyponatremia with CSF findings suggestive of elevated counts and raised protein. All children were treated with doxycycline and azithromycin for 7 days with complete recovery. We aim to create more awareness among clinicians with regard to this treatable cause of neuroinfection which if diagnosed and treated early, have a relatively good prognosis.

Keywords


rickettsia, meningoencephalitis, children

Full Text:

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References


Walker DH. Rickettsiae and rickettsial infections: the current state of knowledge. Clin Infect Dis. Jul 15 2007;45 Suppl 1:S39-44

Ricketts HT. A micro-organism which apparently has a specific relationship to Rocky Mountain spotted fever. JAMA 1909;52: 379 – 380

Jensenius M, Fournier P, Raoult D. Rickettsioses and the international traveler. Clin Infect Dis. 2004;34(10):1493-9

Helmick CG, Bernard KW, D’Angelo LJ. Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases. J Infect Dis 1984;150:480 – 488

Padbidri VS, Gupta NP. Rickettsiosis in India: A review. J Indian Med Assoc 1978; 71: 104-107

N. Murali, Swathi Pillai, Thomas Cherian, P. Raghupathy, V. Padmini, Elizabeth Mathai. Rickeetsial infections in South India: How to spot the spotted fever. Indian Pediatrics 2001; 38: 1393-1396

Marmion BP, Worswick DA. Coxiella burnetii and other medically important members of the family Rickettsiaceae. In: Collee JG, Marmion BP, Fraser AG, Simmons A, editors. Mackie and McCartney practical medical microbiology. New York: Churchill Livingstone; 1996.

Edwards MS, Feigin RD. Rickettsial diseases. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds.Textbook of Pediatric Infectious Diseases. 5th ed. WB Saunders Co; 2004:24972515/Chapter 195.

Rovery C, Raoult D. Meditteranean Spotted Fever. Infect Dis Clin N Am. 2008;22:515-530.

Abramson JS, Givner LB. Rocky Mountain spotted fever. Pediatr Infect Dis J. Jun 1999;18(6):539-40

Sexton DJ, Corey GR. Rocky Mountain "spotless" and "almost spotless" fever: a wolf in sheep's clothing.Clin Infect Dis. 1992;15(3):43948

Ormsbee RA, Rickettsia. In: Practical Medi-cal Microbiology, 13th edn. Eds. Collee JG, Duguid JP, Fraser AG, Marmion BP. New York, Churchill Livingstone, 1989; pp 742-743.

Kovacova E, Kazar J. Rickettsial diseases and their serological diagnosis. Clin Lab 2000; 46: 239-245

Bhattacharya D, Mittal V, Bhatia R, Sehgal S. Comparison between indirect fluorescent antibody and Weil-Felix tests for detecting antibodies against rickettsia. J Commun Dis 1991; 23: 144-148.

Amano K, Hatakeyama H, Okutta M, Suto T, Mahara F. Serological studies of antigenic similarity between Japanese spotted fever rickettsiae and Weil Felix test antigens. J Clin Microbiol. 1992;30:2441–6

Amano K, Suzuki N, Hatakeyama H, Kasahara Y, Fujii S, Fukushi K, et al. The reactivity between rickettsiae and Weil-Felix test antigens against sera of rickettsial disease patients. Acta Virol.1992;36:67–72

Dass R, Deka NM, Duwarah SG, Barman H, Hoque R, Mili D, Barthakur D; Characteristics of pediatric scrub typhus during an outbreak in the North Eastern region of India: peculiarities in clinical presentation, laboratory findings and complications; Indian J Pediatr. 2011;78 (11) :1365-70 Veena Mittal, Naveen Gupta, Dipesh Bhattacharya, Kaushal Kumar, R.L. Ichhpujani, Sharda Singh, Mala Chhabra,,U.V.S. Rana; Serological evidence of rickettsial infections in Delhi; Indian J Med Res. 2012l; 135(4): 538–541. Raoult D, Drancourt M. Antimicrobial therapy of rickettsial diseases. Antimicrob Agents Chemother. 1991;35(12):2457-62

Purvis JJ, Edwards MS. Doxycycline use for rickettsial disease in pediatric patients. Pediatr Infect Dis J. 2000;19(9):871-4