Rickettsial Meningoencephalitis : An under diagnosed entity in developing countries

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.