Scrub Typhus Meningismus: A Diagnostic Dilemma

Scrub typhus is an acute, febrile infectious illness caused by Orientia tsutsugamushi, an obligate intracellular gram negative bacterium. Serious complications occur in the second week of illness. Absence of eschar indicates a high risk of mortality. An interesting case of meningitis is presented here in a 42 -year-old male patient presented with the history of fever and breathlessness for the last seven days and headache, vomiting and disorientation for the last one day. On examination, patient had fever with disorientation and neck rigidity in the initial part of neck flexion in anteroposterior direction only. USG Whole Abdomen revealed hepatosplenomegaly with bilateral mild pleural effusion. Scrub typhus meningismus was diagnosed in the absence of eschar. IgM Scrub typhus antibody was positive by lmmunochromatographic method. The importance of the case lies in the fact that since India is endemic for both Tuberculosis (TB) and Scrub typhus; specific tests like IgM antibody and CSF ADA (Adenosine Deaminase) may go a long way in avoiding unnecessary treatment in patients.