Encephalitis Syndrome Research Articles

Spectrum of computed tomography (Ct)-brain findings in Covid-19 patients with CNS manifestations

Background: Infection with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) results in Corona Virus Disease 2019 (COVID -19) predominantly it affects respiratory system; however it has become apparent that many other organ systems including central nervous system can also be involved. Imaging plays an essential role in diagnosis of all manifestations of the disease and its complications. Objective: To study the spectrum of neuro-imaging findings on CT in COVID-19 patients with CNS symptoms. Material and Methods: Non-contrast CT scan of brain was done in 80 patients of either gender having COVID-19, confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) with CNS manifestations. Images were assessed for presence of abnormal findings like Infarcts, hemorrhage, venous/arterial thrombosis, leukoencephalopathy, white matter disease, hypoxic ischemic injury, encephalitis and posterior reverse encephalopathy syndrome. Results: A total of 80 patients with COVID-19 were reviewed, out of which CT was abnormal in 35 patients (43.7%). findings included various types of infarcts, intra and extra axial haemorrhages, Diffuse axonal injury and PRES (Posterior Reversible Encephalopathy Syndrome). Our study demonstrated that the neurological imaging of patients with COVID-19 were variable without a specific pattern but is dominated by ischemic infarcts and intracranial haemorrhages. Conclusion: C0VID-19 is a serious public health crisis and can have neurological manifestations, therefore these patients should be evaluated early for neurological symptoms as timely analysis and management of neurological complications are key to improving the prognosis.

Eco-epidemiological risk factors for Japanese encephalitis in the endemic region of North East India: a hospital-based case-control study.

Japanese encephalitis (JE) has emerged as a major public health concern in North East India due to its complex eco-epidemiological risk factors. The objective of this study was to understand the various risk factors associated with JE infection in the endemic study location. A hospital-based case-control study was conducted at Jorhat Medical College and Hospital from August 2017 to September 2018. The study participants included 49 confirmed JE cases with two control arms, one consisting of non-JE acute encephalitis syndrome (AES) patients (n = 91) and the other of non-JE non-AES patients (n = 140), admitted at the same time in the pediatric and medicine wards. A predesigned, pretested, structured questionnaire was used for data collection. Univariate analysis revealed the following to be risk factors: age at onset, sex, religion, immunization status, proximity to pigs, proximity to paddy fields (<100 m), use of a mosquito net, impregnated mosquito net, mosquito repellent, and outdoor activities. Multiple logistic regression analysis identified age at onset (adjusted odds ratio [AOR], 20.900; 95% confidence interval [CI], 2.210-31.815) and proximity to pigs (AOR, 4.190; 95% CI, 1.592-11.040) as risk factors for the first control arm and proximity to paddy fields (<100 m) (AOR, 8.470; 95% CI, 2.0251-35.438) was the only risk factor found for second control arm, whereas impregnated mosquito nets (AOR, 0.082; 95% CI, 0.009-0.725) and mosquito repellent (AOR, 0.173; 95% CI, 0.052-0.575) were found to be associated with the second control arm. Age at onset, proximity to pigs, proximity to paddy fields (<100 m), impregnated mosquito nets, and mosquito repellent were the most significant risk factors for JE in the NE region to warrant public health actions.

Trends and seasonality of vector borne diseases in Kerala

Background: Even though epidemiological transition of Kerala is from communicable to non-communicable diseases, re-emerging communicable diseases is a challenge to health service system. Information about disease trends and pattern and seasonal variation is necessary to ensure healthy life. This study aims to find out the trend and pattern in vector borne diseases and its association with seasons.Methods: Study used integrated disease surveillance programme (IDSP) data of vector borne diseases from Directorate of Health Services, Kerala. Seasons are classified as summer, rainy and winter. Mean differences in frequency between two sample proportions (between seasons) were tested using analysis of variance (ANOVA) test.Results: The fluctuations in vector borne disease are mainly due to dengue. Percent share of acute encephalitis syndrome (AES) and Japanese encephalitis (JE) is low but fatality is high among these diseases. Fatality rate for dengue and malaria is low but scrub typhus is high. Thiruvananthapuram is in the first position in reporting these diseases except in 2018, when Malappuram holds the first position. Idukki, Kottayam and Wayanad are the districts with lowest percents. Diseases increase during rainy season.Conclusions: There is necessary monitoring from LSGD and health institutions at primary level to do grass root level sanitation and health awareness to prevent dengue fever. Proper monitoring of entering data from health institutions is needed. The study provides an insight to the vector borne diseases in Kerala which help planning the infrastructure and human resources in public hospitals.

Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam

Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.

An unusual case of steroid unresponsive Hashimoto’s encephalitis in Indian under-5

Hashimoto’s encephalopathy (HE) is a rare entity in children. Usually, it responds very well to steroids. We report a case of steroid-unresponsive HE in a 4-year-old male child presenting with acute encephalitis syndrome with raised intracranial pressure. Serum anti-thyroid peroxidase antibody was high. He was refractory to intravenous immune globulin and steroids. He underwent plasma exchange therapy which had a dramatic response with marked clinical improvement.

Clinicoepidemiological profile and outcome among children with acute encephalitis syndrome from Central India

Background: Acute encephalitis syndrome (AES) is defined as the acute onset of fever and a change in mental status and/or new onset of seizures (excluding simple febrile seizures) in a person of any age at any time of the year. Aims and Objectives: The objectives of the study were as follows: (a) To study clinicoepidemiological profile and outcome among children with AES admitted at M.Y.H. Hospital and MGM Medical College, Indore, M.P., and (b) to study prognostic factors associated with bad outcomes. Materials and Methods: This prospective observational study was conducted over 12 months (July 2019–August 2020) at the pediatric department of our hospital. Inclusion criteria: Inpatient children aged 6 months–14 years meeting the case definitions of acute encephalitis syndrome. Exclusion criteria: Simple febrile seizures. Results: Out of 50 AES cases, majority were between 1 and 5 years of age (40%). There were more males 31 (62%) than 19 (38%) females. Most of the cases were reported during the monsoon period 29 (58%) followed by post-monsoon 13 (26%) and pre-monsoon 8 (16%). Out of 50 cases, all had fever and altered sensorium, 37 (74%) had convulsions, 14 (28%) had vomiting, and 9 (18%) had headache. Out of 50 cases, 42 (84%) had viral etiology including 7 (14%) of dengue encephalitis and 1 (2%) of case of human immunodeficiency virus encephalitis. Only 5 (10%) cases had bacterial etiology. Those who needed inotropes and mechanical ventilation showed significant mortality. Conclusion: The peak of AES cases occurred during the monsoon period. A higher proportion of such cases had viral etiology on cerebrospinal fluid analysis. Use of inotropes and mechanical ventilation was identified to be associated with significant mortality.

Bayesian Survival Analysis of Acute Encephalitis Syndrome with Censoring Mechanism using Brms Package

Bayesian Survival Analysis of Acute Encephalitis Syndrome with Censoring Mechanism using Brms Package

Who Is at Risk? A Critical Case of Japanese Encephalitis.

Japanese encephalitis (JE) is critical epidemic encephalitis caused by the JE virus (JEV) in Southeast Asia. The World Health Organization defined "acute encephalitis syndrome" (AES) as an acute onset of fever with a change of mental status and/or new-onset seizure, mainly for the surveillance of JE. The key clues for the diagnosis include the patient age group of unvaccinated era or waning vaccine-induced immunity and the history of possible mosquito bites in epidemic areas. We report a 47-year old man who is in an unvaccinated era with potential waning immunity. The patient presented with fever and altered mental status for 2 days. He was speechless and could not follow commands. The patient had gone camping in the countryside a week before the visit. At the emergency department, neck stiffness was noted. There was a leukocytosis with a left shift by blood cell count. The brain computed tomography was essentially normal. The cerebrospinal fluid (CSF) sample via lumbar puncture showed leukocytosis, a high protein level, and a low sugar level in comparison to serum tests. Further antibody test of CSF confirmed the diagnosis. Magnetic resonance imaging (MRI) of the brain revealed a high signal in the right thalamus and a mildly swollen left caudate nucleus 4 days after admission. He was extubated and finally discharged with partial dependency on activities of daily living. This case reminds us of the JE in AES. Emergency physicians should be aware of the suspicious case of unvaccinated age or waning immunity and possible mosquito bites in epidemic areas. The role of MRI on JE was also discussed in this article.

Neurological and Neuroradiological Patterns with COVID-19 Infection in Children: A Single Institutional Study.

Background Varied neurological manifestations in pediatric patients with coronavirus disease 2019 (COVID-19) have been increasingly reported from all across the world in the scientific literature. Objective We aimed to evaluate pediatric cases with neurological symptoms and neuroimaging findings with COVID-19 infection in our hospital. Materials and Methods Children from 0 to 12 years with laboratory evidence of COVID-19 infection and acute neurological manifestations within 3 months, who have undergone magnetic resonance imaging (MRI) were included in the study. We categorized them based on neurological findings into four groups: acute encephalitis syndrome (AES), acute flaccid paralysis (AFP), cerebrovascular event/stroke, and miscellaneous consisting of acute seizures without encephalopathy. Results A total of 19 children with neurological manifestations related to COVID-19 infection were included in the study. AES was the most common neurological syndrome seen in 47.36%, followed by AFP in 26.31% and cardiovascular event/stroke in 21.05%. Seizure was the most common neurological symptoms in 62.15%, followed by encephalopathy in 42.10% and AFP in 26.31%. On neuroimaging, pattern observed were immune-mediated cauda equina nerve roots enhancement in 26.31% or acute disseminated encephalitis in 5.26%, small acute infarcts, hippocampal, and bilateral thalamic signal changes seen in 21.05% each, microhemorrhages and leukoencephalopathy in 15.78%, and coinfection in 5.26%. Conclusion In our study, seizures and encephalopathy were the most common neurological symptoms with COVID-19 infection. Postinfectious immune-mediated cauda equina nerve root enhancement or acute demyelinating encephalomyelitis-like brain imaging, followed by small acute infarcts and hippocampal/thalamic signal changes were most common imaging patterns. We found overlapping neurological and MRI patterns in many children, suggesting that various pathophysiological mechanisms act individually or synergistically.

COVID-19 and Central Nervous System Diseases

We reviewed the influence of coronavirus disease 2019 (COVID-19) on the central nervous system reported in the literature since its prevalence. Common neurological symptoms of COVID-19 include altered or impaired consciousness, headache, dizziness, cerebrovascular accidents, and seizures, etc. Encephalopathy caused by or related to COVID-19 includes stroke, acute encephalitis, and Guillain-Barre syndrome. Concomitant COVID-19 in patients with vascular risk factors increased the risk of stroke; the hypercoagulable state and vascular dysfunction caused by COVID-19 also led to stroke. Acute encephalitis was usually accompanied by a history of headache, fever, and altered mental status, and shown hemorrhagic lesions or high signal on MRI. In Guillain-Barre syndrome, there was a time lag between infection with the primary pathogen and the onset of neurological symptoms, which generally manifest as limb paralysis and various sensory abnormalities. The review illustrated that COVID-19 lead to serious consequences of brain and brought difficulties to the treatment. Exploring the neural mechanisms of COVID-19 to better understand the activity of the virus in the brain and to prevent further viral damage to the brain is an urgent issue.

A reverse genetics and genomics approach to gene paralog function and disease: Myokymia and the juxtaparanode

The leucine-rich glioma-inactivated (LGI) family consists of four highly conserved paralogous genes, LGI1-4, that are highly expressed in mammalian central and/or peripheral nervous systems. LGI1 antibodies are detected in subjects with autoimmune limbic encephalitis and peripheral nerve hyperexcitability syndromes (PNHSs) such as Isaacs and Morvan syndromes. Pathogenic variations of LGI1 and LGI4 are associated with neurological disorders as disease traits including familial temporal lobe epilepsy and neurogenic arthrogryposis multiplex congenita 1 with myelin defects, respectively. No human disease has been reported associated with either LGI2 or LGI3. We implemented exome sequencing and family-based genomics to identify individuals with deleterious variants in LGI3 and utilized GeneMatcher to connect practitioners and researchers worldwide to investigate the clinical and electrophysiological phenotype in affected subjects. We also generated Lgi3-null mice and performed peripheral nerve dissection and immunohistochemistry to examine the juxtaparanode LGI3 microarchitecture. As a result, we identified 16 individuals from eight unrelated families with loss-of-function (LoF) bi-allelic variants in LGI3. Deep phenotypic characterization showed LGI3 LoF causes a potentially clinically recognizable PNHS trait characterized by global developmental delay, intellectual disability, distal deformities with diminished reflexes, visible facial myokymia, and distinctive electromyographic features suggestive of motor nerve instability. Lgi3-null mice showed reduced and mis-localized Kv1 channel complexes in myelinated peripheral axons. Our data demonstrate bi-allelic LoF variants in LGI3 cause a clinically distinguishable disease trait of PNHS, most likely caused by disturbed Kv1 channel distribution in the absence of LGI3.

Japanese encephalitis presenting as transverse myelitis: An uncommon presentation

Japanese Encephalitis Virus (JEV) is the main cause of viral encephalitis in South East Asia. Commonly, it presents as an acute encephalitic syndrome with fever, headache, seizures, and altered sensorium as clinical manifestations. However, there can be atypical presentations such as acute transverse myelitis (ATM) as the initial manifestation. Clinicians should be aware of such possibilities and myelitis due to the JE virus should be considered as a differential in children presenting with encephalomyelitis.

In silico Analysis of ACE2 Receptor to Find Potential Herbal Drugs in COVID-19 Associated Neurological Dysfunctions

COVID-19 mainly causes the collapse of the pulmonary system thereby causing a dearth of oxygen in the human body. Patients infected with this viral disease have been reported to experience various signs and symptoms associated with brain dysfunction, from the feeling of vagueness to loss of smell and taste to severe strokes. These neurological problems have been reported by younger COVID-19 infected patients mainly in their thirties and forties. Various researchers from around the globe have discerned numerous other brain dysfunctions, such as headache, dizziness, numbness, major depressive disorder, anosmia, encephalitis, febrile seizures, and Guillain-Barre syndrome. The involvement of the CNS by this viral infection has been predicted to be for a longer period of time, even if the patient recovers from COVID-19. The neuronal cell damage caused by COVID-19 is a potent factor responsible for cognitive, behavioral, and psychological problems among its sufferers. The hypoxic conditions can also trigger the formation of beta-amyloid plaques and tau-tangles and thus the virus can even induce Alzheimer’s in patients in the near future. The virus affects the brain directly, thereby causing encephalitis. This pandemic has also been shown to have a negative psychological toll on people. This research aims to highlight the brain dysfunction associated with the ACE2 receptor that is known to be a crucial player in the COVID-19 pandemic using genetic networking approaches. Furthermore, we have identified herbal drug candidates that bind to the ACE2 receptor in order to identify potential treatments for the neurological manifestations of COVID-19.

Infectious causes of acute encephalitis syndrome hospitalizations in Central India, 2018-20.

We enhanced surveillance of hospitalizations of all ages for acute encephalitis syndrome (AES) along with infectious aetiologies, including the Japanese encephalitis virus (JEV). From October 2018 to September 2020, we screened neurological patients for AES in all age groups in Maharashtra and Telangana States. AES cases were enrolled at study hospitals along with other referrals and sampled with cerebrospinal fluid, acute and convalescent sera. We tested specimens for non-viral aetiologies viz. leptospirosis, typhoid, scrub typhus, malaria and acute bacterial meningitis, along with viruses - JEV, Dengue virus (DENV), Chikungunya virus (CHIKV), Chandipura virus (CHPV) and Herpes simplex virus (HSV). Among 4977 neurological hospitalizations at three study site hospitals over two years period, 857 (17.2%) were AES. However, only 287 (33.5%) AES cases were eligible. Among 278 (96.9%) enrolled AES cases, infectious aetiologies were identified in 115 (41.4%) cases, including non-viral in 17 (6.1%) cases - leptospirosis (8), scrub-typhus (3) and typhoid (6); and viral in 98 (35.3%) cases - JEV (58, 20.9%), HSV (22, 7.9%), DENV (15, 5.4%) and CHPV (3, 1.1%). JEV confirmation was significantly higher in enrolled cases than referred cases (10.2%) (p<0.05). However, the contribution of JEV in AES cases was similar in both children and adults. JE was reported year-round and from adjacent non-endemic districts. The Japanese encephalitis virus continues to be the leading cause of acute encephalitis syndrome in central India despite vaccination among children. Surveillance needs to be strengthened along with advanced diagnostic testing for assessing the impact of vaccination.

Fog-Computing Based Healthcare Framework for Predicting Encephalitis Outbreak

Acute Encephalitis Syndrome (AES) is a serious, life-threatening disease, which is endemic in India and South-East Asia, where it adds to the strain on healthcare systems. It is a communicable disease that is caused by a virus attacking the brain tissues. The main objective of this study is to present a system that allows for monitoring, controlling, and preventing the spread of Encephalitis. The system is based on Hybrid-Fog-Computing (HFC) for real-time alert generation and notifies medical caregivers in case of abnormal geospatial distribution of infections. Deep learning, incorporating Multi-scaled Long Short Term Memory (MLSTM) and Convolutional Neural Network (CNN), is used to identify the health risk in terms of the Outbreak Severity Index (OSI). Our deep-learning model is integrated with Geographical Information System (GIS) tools to analyze the spatial distribution of disease-ridden areas and a Self-Organized Mapping (SOM) technique is used to visualize AES hotspots using spatial cluster analysis techniques including Getis-Ord Gi*. To determine the category of a patient's health state, a Bayesian classifier is used. A Spatio-temporal prediction model is used to coordinate medical resources toward successful health-oriented decision-making and effective knowledge delivery. The system is validated using real datasets, and the results are compared to various state-of-the-art prediction models. The proposed model outperforms other decision models for accuracy, precision, f-measure, and overall system stability.

Prevalence of Thrombocytopenia in Acute Kidney Injury Cases Associated Scrub Typhus

Scrub typhus is a vector borne zoonotic disease producing varieties of clinical complications like acute encephalitis syndrome (AES), Acute respiratory distress syndrome (ARDS), multi organs dysfunction(MODS) and deaths also. Acute kidney injury (AKI) is one of the common clinical manifestations while progressing for MODS, where AKI has been found to be associated with thrombocytopenia .In this review a small effort has been made to throw light upon prevalence of thrombocytopenia in scrub typhus cases.

Genotypic Characterization of Orientia tsutsugamushi Isolated From Acute Encephalitis Syndrome and Acute Febrile Illness Cases in the Gorakhpur Area, Uttar Pradesh, India.

Scrub typhus infections caused by Orientiatsutsugamushi (OT), continue to remain underdiagnosed globally, due to the lack of distinctive symptoms. The elusive nature of the Acute Encephalitis Syndrome (AES) outbreak in Gorakhpur, Uttar Pradesh that claimed numerous pediatric lives was the driving force of this study which involved serological diagnosis (IgM–ELISA), isolation of OT in cell culture, confirmation by PCR, and characterization by Sanger sequencing. In total, 12 out of 36 patients were seropositive, of which 4 were positive by PCR. Upon enrichment in cell culture, additional 3 patients (including two seronegative) were detected positive by PCR. In total, three of these 7 patients were found to be infected with two strains of OT. Taken together, this study for the first time reports the occurrence of dual infections in addition to three circulating OT genotypes (Gilliam, Kato, and Karp-like) and highlights the significance of enriching OT in cell culture systems for efficient molecular detection.

Role of Serum Ferritin and PRISM-III in Predicting Mortality in Children with Acute Encephalitis Syndrome in Northern India

AbstractThe aim of this study was to evaluate the role of serum ferritin (SF) and PRISM-III (Pediatric Risk of Mortality) score in predicting mortality in critically ill children aged 6 months to 15 years diagnosed with acute encephalitis syndrome (AES) admitted to the pediatric intensive care unit (PICU). This prospective observational study was conducted in the PICU of a tertiary teaching hospital in Northern India between July 2018 and June 2019. The primary outcome was to determine the association of admission SF levels with mortality. Secondary outcomes included estimating the prevalence of hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality. Etiology could be established in 85.5% (n = 219) of the 256 children enrolled. Scrub typhus accounted for nearly two-thirds of the cases (60.5%), while dengue and Japanese encephalitis were the next common diagnoses. The median [interquartile range] SF at admission was significantly higher among the nonsurvivors than survivors: 514 [260–1,857] and 318 [189–699] µg/L, respectively (p = 0.029). SF and PRISM-III independently predicted mortality in AES. However, both had poor discriminatory power with area under receiver operating curve (95% confidence interval) of 0.61 (0.51–0.72) and 0.67 (0.56–0.77), respectively. Elevated SF and higher PRISM-III scores independently predicted mortality in children admitted to PICU with AES.

Viral Etiology in Acute Encephalitis Syndrome in North Indian Children

Background and Objective: Acute Encephalitis Syndrome (AES) leads to significant mortality and morbidity in children. This study was undertaken to identify the viral causes of AES and its correlation with clinicodemographic profile. Methods: This cross-sectional study included 100 children aged 1 to 12 years presenting with fever of &lt;14 days duration and a change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) and/or new onset of seizures (excluding simple febrile seizures) [1]. Cerebrospinal Fluid (CSF) was collected aseptically by lumbar puncture for biochemical and cytological analysis, and for bacteriological culture. Multiplex PCR for the viruses HSV1, HSV2, Varicella zoster virus, Enterovirus, Mumps and Parecho virus was carried out. Serology for Japanese Encephalitis (JE) was done in blood and CSF by ELISA method. Dengue NS1 antigen and IgM ELISA was carried out in both blood and CSF samples. Serum IgM antibody for scrub typhus was done by ELISA method. Results: Out of 100 children viral cause was detected in 21 patients (Japanese encephalitis -16, Dengue – 4, Varicella zoster virus, Enterovirus and Mumps virus – 1 each). Serum IgM ELISA for scrub typhus was positive in 6 patients. Multiple viral etiology was seen in 2 patients. Mortality was significantly more in females (p=0.021), GCS &lt;8 (p &lt;0.001). Mortality was significantly more with higher CSF neutrophils and higher proteins (p&lt;0.05). Interpretation and Conclusion: This study concludes that viral causes specially JE contributed in AES in North India. Hence viral pathogens including JE needs to be considered as one of major causative agents while treating patients of AES and further emphasis has to be given for JE vaccination in this region.

All about scrub typhus

Introduction: Rickettsia is Gram-negative, non-motile, obligate intracellular proteobacteria. They stay in various forms such as coccus, bacillus, and threads. At times, they are regarded as coccobacilli. No human-to-human transmission is there. They always need a vector such as fleas, lice, mite, and ticks for transmission. Rickettsiae species were classically divided into spotted fever and typhus groups. Scrub typhus also known as bush typhus is an important cause of acute febrile illness in South and East Asia and Pacific. It is caused by the intracellular parasite Orientia tsutsugamushi, a gram negative alpha proteobacterium of family Rickettsiaceae which was first isolated and identified in 1930 in Japan. It is distinct from other Rickettsiae in that it lacks both peptidoglycan and lipopolysaccharide in its cell wall. Like other vasculotropic rickettsiae, it affects vascular endothelial cells causing vasculitis. It also affects macrophages and cardiac myocytes. Objectives: This review will give a way forward regarding all information about scrub typhus in detail. Materials and Methods: Various clinical profile especially clinical features, presence or absence of ESCHAR, organ invovement, investigations, treatment and final outcome was studied in detail. Results: Clinical results, investigations were analysed to stamp the diagnosis. Different modalities of management has interpreted well. Conclusion: Among all rickettsial infections, scrub typhus being most common is seen all over Indian states and UTs. A child presenting to ER with fever of unknown origin, nephropathy, acute encephalitic syndrome, hepatosplenomegaly, lymphadenopathy, and also hypotension pointing toward possibility of scrub, hence, a detailed search for ESCHAR being essential in clinical examination.