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  • Title: Diagnostic Dilemma between Scrub Typhus Meningoencephalitis and Dengue Encephalopathy Resolved! - A Novel Prediction Score.
    Author: Alam A, Agarwal P, Jain A, Kalyan RK, Kumar R, Fellowship Pediatric Neurology.
    Journal: Neurol India; 2024 Sep 01; 72(5):1040-1046. PubMed ID: 39428778.
    Abstract:
    BACKGROUND: Scrub typhus and dengue, common etiologies of acute encephalitis syndrome, present with similar clinico-laboratory profiles but differ in management protocol. OBJECTIVE: We aimed to devise a score differentiating between scrub typhus meningoencephalitis (STM) and dengue encephalopathy (DE). METHODS: A prospective cohort of 204 children, (aged 6 months to 14 years) presenting with acute encephalitis syndrome in a public teaching hospital in northern India was subjected to standardized workup including serum IgM against Orientia tsutsugamushi and Dengue virus. Clinico-laboratory features were compared between STM and DE using univariate and multivariate analysis. Area under the receiver operating characteristic (ROC) curve (AUROC) for the score derived from independent predictors and its sensitivity, specificity, predictive values was calculated at cutoffs. RESULTS: STM and DE IgM ELISA were positive in 38 (18.6%) and 41 (20.1%) children, respectively. Longer duration of fever, prodromal stage, respiratory complaints and pneumonia were significantly frequent in STM; however, swelling, petechiae and myalgia were significantly prevalent in DE. STM had higher blood total leukocyte count (TLC), higher CSF protein and lower CSF sugar compared to DE. At admission, TLC >10,000/mm3, pneumonia, absence of myalgia and petechiae were independent predictors for differentiating STM from DE. AUROC of novel score (range: -5 to 5) was 0.879 (95% CI: 0.805-0.952). Score at cutoff ≥5 had 100% specificity and 100% PPV for differentiating STM from DE. CONCLUSIONS: Prediction score may benefit physicians to differentiate between these two infections and treat them accordingly.
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