A Neonate with Bacterial Meningitis Due to Vertically Transmitted Scrub Typhus

Figures & data

Table 1 Demographic Characteristics, Symptoms, Laboratory Characteristics and Prognoses of Neonates and Mothers with Scrub Typhus

Cases	Age	Gender	Symptom	Examination	Mother	Immun of luorescent Assay	Prognosis
Wang C L et al^Citation4 1992	26 days	Male	Intermittent high fever, abdominal distention, and skin pallor, without petechiae or eschar	Hepatosplenomegaly, AST: 92 IU/L, ALT: 54 IU/L, CSF: 350 per high power field (red blood cells, 170, and white blood cells, 180, 37% polymorphs, and 63% mononuclear cells), protein concentration was 128 mg/dL, and glucose concentration was 79 mg/dL.	Febrile on the fourth postpartum day and persisted for 1 week.	Baby: OX-K titer >1:320, IgM titer >1: 160 (Kato), Mom: elevation of specific IgM antibody to Karp, Gilliam	Complicated with meningitis and disseminated intravascular coagulopathy.
Suntharasaj, T et al^Citation5 1997	preterm	Male	Anemia, sepsis and disseminated intravascular coagulation, without petechiae or eschar	Hepatosplenomegaly	A high grade fever, chill, dry cough, headache, and pneumonitis.	Baby: OX-K titer >1: 320, IgM titer >1: 400. Mom: OX-K titer >1: 320, IgM titer >1: 400.	Recovered with mildly retarded growth and encephalomalacia.
Vajpayee, S. et al^Citation6 2017	28 days	Male	Icterus, abdomen distension, and mild fever, without petechiae or eschar	Hepatomegaly with acute liver failure.	No describe	Baby and Mom: elevation of specific IgM antibody.	Recovered without sequelae.
Our case	10 days	Male	Reversed high grade fever, jaundice, and seizures, without petechiae or eschar	Hepatomegaly, AST: 336.6U/L, ALT: 1317.1U/L, CSF: white blood cells at 283×10^6/L with 95.1% monocytes, 4.9% polymorphonuclear neutrophils, protein concentration of 3.084 g/L and glucose concentration of 1.18 mmol/L.	Anemia and reversed fever, with eschar.	Baby: OX-K titer >1: 160, IgM titer >1: 160 (Karp) Mom: OX-K titer >1: 640, IgM titer >1: 160 (Karp).	Recovered without sequelae.

Abbreviations: AST, aspartate aminotransferase; ALT, alanine aminotransferase; CSF, cerebrospinal fluid.

Figure 1 (A) On the first day of admission, the baby was suspected of neonatal bacterial meningitis, and CT showed that patchy low-density areas in the bilateral frontal, temporal and parietal lobes (arrow). (B) On the eighth day of the patient’ mother had fever, the local doctor suspected that she was infected with tsutsugamushi disease, and found an 1.2×0.8 cm eschar on her left groin.

Wang CL, Yang KD, Cheng SN, Chu ML. Neonatal scrub typhus: a case report. Pediatrics. 1992;89(5):965–968. doi:10.1542/peds.89.5.965

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Suntharasaj T, Janjindamai W, Krisanapan S. Pregnancy with scrub typhus and vertical transmission: a case report. J Obstet Gynaecol Res. 1997;23(1):75–78. doi:10.1111/j.1447-0756.1997.tb00809.x

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Shailja V, Gupta RK, Gupta ML. Scrub typhus causing neonatal hepatitis with acute liver failure-A case series.[J]. Indian J Gastroenterol. 2017;36(3):239–242. doi:10.1007/s12664-017-0761-5

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