Neuropharmacology

Biography

Biography: Masaraf Hussain

Abstract

Scrub typhus also known as tsutsugamushi disease is an acute febrile illness caused by Orientia tsutsugamushi. It is seen in terrains of the “tsutsugamushi triangle”. In the state of Meghalaya situated in North –East India , the disease is well known among the local people as “niangsohot” which means organisms associated with chestnut. Central nervous system involvement is a known complication of scrub typhus, and it ranges from meningitis to meningoencephalitis. The name “typhus” itself is derived from the Greek word “typhos”which means stupor. The study carried out revealed fever with headache and altered sensorium , as the most common presentation of Scrub typhus meningoencephalitis. The duration of fever was longer than that of viral and bacterial meningitis. However differentiating it from Tuberculous meningitis is a challenge, even with cerebrospinal fluid analysis. The pathognomic ‘eschar’ helps in early diagnosis of scrub typhus infection. Doxycycline is the drug of choice. However it is bacteriostatic to O.tsutsugamushi ,and does not cross the blood brain barrier beyond 15-30%.Sometimes progressive neurological damage has occurred inspite of treatment with doxycycline, either due to resistance, immune mediated injury or drug interaction. Injectable azithromycin is a good alternative . In the above study as most patients were critically ill, and injectable doxycycline was not available, injectable azithromycin was used along with oral doxycycline. Recovery was seen in 84.61% patients. Recovery was brisk, and signs of improvement was seen within 48 hours of starting specific therapy. Therefore timely initiation of therapy is essential to avoid mortality and morbidity.