Differentiating Scrub Typhus Meningoencephalitis, from Tuberculous Meningitis: Two Case Reports and a Review

Abstract

Scrub typhus is a zoonotic disease where currently about one million new cases are identified annually and one billion people may be at risk of this disease (1-3). The infection is acquired through agricultural activities in the rice fields, oil palm, rubber plantation and during recreational activities in the woods or mountainous areas which are common in Southeast Asia (4). Scrub typhus is underdiagnosed due to its nonspecific clinical presentation and lack of diagnostic facilities. The clinical manifestations of the disease range from sub- clinical disease to fatal organ failure (5) and it is commonly observed in endemic areas as one of the causes of fever of unknown origin (6). The pathognomonic clinical sign of scrub typhus is the presence of an eschar (60%) (7-9), which may be hidden and painless as it is often present in areas like breast folds, groin, external genitalia and gluteal folds which may go unnoticed in dark-skinned individuals.