ABSTRACT

Scrub typhus caused by Orientia tsutsugamushi is a re-emerging infection in India. In children, it presents with a variety of symptoms, including the comparatively rare and less studied neurological manifestations. A 7-year-old boy presented with sudden onset difficulty in walking, respiratory distress, slurring of speech and a history of fever. There were acute cerebellar signs followed by quadriparesis with hypertonia, exaggerated deep tendon reflexes, bilateral extensor plantar response and loss of spontaneous respiratory effort, requiring mechanical ventilation on Day 3. Complete blood count (CBC) demonstrated lymphocytic leucocytosis; cerebrospinal fluid (CSF) analysis was normal. Owing to a suspected demyelinating disorder, he was commenced on intravenous (IV) pulse methylprednisolone 30 mg/kg . CSF and blood were positive for scrub typhus infection and on Day 5 he was commenced on IV azithromycin 10 mg/kg. On Day 7 there was considerable neurological improvement with reduction of raised intracranial pressure and on Day 9 he was extubated. Magnetic resonance imaging (MRI) of brain on Day 10 suggested low-grade glioma or demyelination in the medulla oblongata. Subsequent magnetic resonance spectroscopy findings supported a demyelinating disorder. After completing the course of methylprednisolone, he was commenced on oral corticosteroids and, during discharge, there was only minimal residual neurological abnormality. After discharge, prednisolone was gradually tapered over 6 weeks and the 3-month repeat MRI demonstrated considerable improvement with only a small focus of demyelination visible around the medulla. This is the first paediatric case of scrub typhus-induced cerebellitis and acute demyelination of the medulla that responded well to corticosteroid therapy.

Abbreviations

ADEM: acute disseminated encephalomyelitis; CT: computed tomography; MRI: magnetic resonance imaging; PGCS: paediatric Glasgow coma scale; PICU: paediatric intensive care unit

中文翻译：

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一名 7 岁男孩因恙虫病导致延髓急性脱髓鞘：病例报告

摘要

恙虫病引起的恙虫病是印度重新出现的感染。在儿童中，它会出现多种症状，包括相对罕见且研究较少的神经系统表现。一名 7 岁男孩突然出现行走困难、呼吸窘迫、口齿不清和发热史。出现急性小脑体征，随后出现四肢瘫痪伴肌张力亢进、深部肌腱反射过度、双侧足底伸肌反应和自主呼吸努力丧失，需要在第 3 天进行机械通气。全血细胞计数 (CBC) 显示淋巴细胞增多；脑脊液（CSF）分析正常。由于疑似脱髓鞘疾病，他开始静脉注射（IV）甲基强的松龙 30 mg/kg。CSF 和血液对恙虫病感染呈阳性，第 5 天开始静脉注射阿奇霉素 10 mg/kg。在第 7 天，随着颅内压升高的降低，他的神经功能得到了显着改善，在第 9 天，他拔管了。第 10 天的脑磁共振成像 (MRI) 提示延髓中存在低级别胶质瘤或脱髓鞘。随后的磁共振波谱发现支持脱髓鞘疾病。在完成甲基强的松龙疗程后，他开始口服皮质类固醇，出院期间仅有极少的残余神经异常。出院后，泼尼松龙在 6 周内逐渐减量，3 个月的重复 MRI 显示明显改善，仅在髓质周围可见少量脱髓鞘病灶。

缩写

ADEM：急性播散性脑脊髓炎；CT：计算机断层扫描；MRI：磁共振成像；PGCS：小儿格拉斯哥昏迷量表；PICU：儿科重症监护病房