Scrub typhus mimicking Parkinson’s disease

BMC Research Notes

H. Janaka de Silva¹  N. K. B. K. R. G. Wijesinghe Bandara¹  J. K. N. Dhanushka Miththinda¹  S. H. Nuwan Chamara Wijayalath¹  Ranjan Premaratna¹ 

[1] Colombo North Teaching Hospital, Ragama, Sri Lanka

关键词: Orientia tsutsugamushi;    Parkinson;    Scrub typhus;   

Others  :  1230153
DOI  :  10.1186/s13104-015-1428-x

 received in 2015-02-01, accepted in 2015-09-09,  发布年份 2015

【 摘 要 】

Background

Scrub typhus is a re-emerging infection in Sri Lanka. It often poses a diagnostic challenge and tends to present as a febrile illness of uncertain origin. Undiagnosed illness may progress to serious multi-systemic complications. Here we report a case of scrub typhus presenting with features of Parkinsonism.

Case presentation

A 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka presented with high fever with malaise, myalgia and arthralgia for 17 days. On the 5th day of illness he developed intermittent resting tremor in his right arm and leg associated with stiffness, difficulty in carrying out normal work and difficulty in smiling. He denied similar previous episodes. There were no other associated neurological manifestations. Clinical examination revealed a high amplitude low frequency resting tremor in his right hand, a mask-like face and increased muscle tone limited to the right side with normal reflexes. The rest of the system examination was normal except for an eschar over the abdomen. His investigations revealed lymphocytic leukocytosis, high erythrocyte sedimentation rate and immunofluorescence assay-IgM and IgG against Orientia tsutsugamushi Karp antigen were positive with rising titers. With oral doxycycline and azithromycin his fever settled within 48 h and a complete recovery of Parkinson’s features was observed within 2 weeks.

Conclusion

Doctors practicing in endemic regions should be familiar with delayed clinical manifestations of scrub typhus and should carefully look for an eschar in order to avoid delay in the diagnosis.

【 授权许可】

   
2015 Premaratna et al.

【 图 表 】

Fig.1.

Fig.2.

Fig.3.

Fig.4.

【 参考文献 】

• [1]Walker DH: Rickettsiae and rickettsial infections: the current state of knowledge. Clin Infect Dis 2007, 45(Suppl 1):S39-S44.
• [2]Jensenius M, Fournier P, Raoult D. Rickettsioses and the international traveler. Clin Infect Dis. 2004;34:1493–9. (Medline).
• [3]Center of Disease Control and Prevention (CDC). Rickettsial diseases. Infectious disease information. http://www.cdc.gov/ncidod/dvrd/branch/vrzb.htm. Accessed 10 Jan 2015.
• [4]Saah AJ. Orientia tsutsugamushi (scrub typhus) In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious disease. 5th ed. Philadelphia: Churchill Livingstone; 2000. p. 2056–7.
• [5]Premaratna R, Loftis AD, Chandrasena TG, Dasch GA, de Silva HJ: Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: a hospital-based study. Int J Infect Dis. 2007, 12:198-202.
• [6]Kularatne SAM, Edirisingha JS, Gawarammana IB, Urakami H, Chenchittikul M, Kaiho I. Emerging rickettsial infections in Sri Lanka: the pattern in the hilly Central Province. Trop Med Int Health. 2003;8:803–11.
• [7]Premaratna R, Rajapakse RP, Chandrasena TG, Nanayakkara DM, Bandara NK, Kularatna SA, et al. Contribution of rickettsioses in Sri Lankan patients with fever who responded to empirical doxycycline treatment. Trans R Soc Trop Med Hyg. 2010;104:368–70. doi:10.1016/j.trstmh.2009.10.006.
• [8]Premaratna R, Chandrasena TGAN, Dassayake AS, Loftis AD, Dasch GA, de Silva HJ. Acute hearing loss due to scrub typhus: a forgotten complication of a re-emerging disease. Clin Infect Dis. 2006;42:6–8. doi:10.1086/498747.
• [9]Alarcón F, Gimenéz-Roldán S: Systemic diseases that cause movement disorders. Parkinsonism Relat Disord. 2005, 11:1-18.
• [10]Barton B, Zauber SE, Goetz CG. Movement disorders caused by medical disease. Semin Neurol. 2009;29:97–110. (2006; 42: e6–8).
• [11]Yum KS, Na SJ, Lee KO, Ko JH: Scrub typhus meningo-encephalitis with focal neurologic signs and associated brain MRI abnormal findings: literature review. Clin Neurol Neurosurg 2011, 113:250-253.
• [12]Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K: Rickettsial meningitis andencephalitis. Arch Intern Med 1991, 151:1753-1757.
• [13]Kim DE, Lee SH, Park KI, Chang KH, Roh JK: Scrub typhus encephalomyelitis with prominent focal neurologic signs. Arch Neurol 2000, 57:1770-1772.
• [14]Gulati S, Maheshwari A: Neurological manifestations of scrub typhus. Ann Indian Acad Neurol. 2013, 16:131.
• [15]Chiou YH, Yang CJ, Lai TH: Scrub typhus associated with transient Parkinsonism and myoclonus. J Clin Neurosci. 2013, 2:182-183.
• [16]Izzard L, Fuller A, Blacksell SD, Paris DH, Richards AL, Aukkanit N, et al.: Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient infected in Dubai. J Clin Microbiol 2010, 48:4404-4409.