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Meningitis due to scrub typhus: the importance of a differential diagnosis in an endemic area

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By Sudeep Adhikari, Patan Academy, Buddhi Paudyal, Keshav Raj Sigdel
| bmj.com
A patient with fever and neck stiffness was treated as partially treated bacterial meningitis based on history, examination and cerebrospinal fluid analysis. After initial improvement with ceftriaxone, vancomycin and dexamethasone, symptoms recurred. Fever resolved promptly after treatment was started with doxycycline, when scrub typhus immunoglobulin M test came positive. Meningitis is a well-known complication of scrub typhus.
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