# Differentiating scrub typhus meningitis from brucellar meningitis in children: A single-center retrospective study

## TL;DR

This study compares two types of childhood meningitis and finds that serum ferritin and PCT levels may help distinguish between them early on.

## Contribution

The study identifies serum ferritin and PCT as potential early biomarkers for differentiating scrub typhus from brucellar meningitis in children.

## Key findings

- Scrub typhus meningitis had shorter fever duration and higher serum ferritin, PCT, CRP, and creatinine levels.
- Ferritin and PCT showed high diagnostic accuracy (AUC 0.870 and 0.846, respectively) in differentiating the two conditions.
- All patients recovered fully with targeted treatment, highlighting the importance of early diagnosis.

## Abstract

To investigate the clinical distinctions between scrub typhus meningitis and brucellar meningitis in children, and to identify potential biomarkers with early differential diagnostic value to support clinical decision-making.

A retrospective analysis was conducted on 13 pediatric patients diagnosed with brucellar meningitis admitted to Kunming Children’s Hospital over the past decade. Thirteen cases of scrub typhus meningitis were selected as controls using an age- and sex-matching strategy. The clinical manifestations, laboratory findings, and cerebrospinal fluid (CSF) characteristics were compared between the two groups. Receiver operating characteristic (ROC) curve was employed to assess the diagnostic performance and clinical utility of key biomarkers.

The pre-admission fever and duration of fever were significantly shorter in the scrub typhus meningitis group. Laboratory evaluation revealed that serum ferritin, procalcitonin (PCT), C-reactive protein (CRP), and creatinine (Cr) levels were markedly higher in the scrub typhus group compared with the brucellosis group. No statistically significant differences were observed in CSF biochemical parameters. ROC analysis demonstrated that ferritin (AUC = 0.870) and PCT (AUC = 0.846) exhibited the greatest diagnostic accuracy, followed by CRP (AUC = 0.814) and Cr (AUC = 0.799). All patients achieved complete clinical recovery following standardized treatment, with no recurrences or fatalities.

Although scrub typhus meningitis and brucellar meningitis share considerable clinical overlap in children, serum ferritin and PCT levels may represent potential diagnostic signals for early differential diagnosis, warranting validation in larger prospective cohorts. High Ferritin levels or PCT levels may provide preliminary clues toward scrub typhus meningitis. Early recognition and targeted antimicrobial therapy are associated with favorable prognostic outcomes.

In this study, we focus on distinguishing between childhood scrub typhus (ST) and brucella meningitis. Given the numerous clinical similarities between these two diseases, accurate early diagnosis is crucial for effective clinical treatment. Through a retrospective analysis of 13 cases of brucella meningitis over a ten-year period at Kunming Children’s Hospital, and employing propensity score matching, we selected 13 cases of ST meningitis as a control group. Our findings revealed that the duration of fever in the ST meningitis group was shorter, while laboratory tests showed significantly higher levels of serum ferritin, procalcitonin (PCT), C-reactive protein (CRP), and creatinine (Cr) in the ST group compared to the brucella group. Serum ferritin and PCT levels demonstrated potential high diagnostic accuracy in ROC curve analysis for distinguishing between the two forms of meningitis. Our research suggests that serum ferritin and PCT levels may serve as important early biomarkers for differentiating these two types of meningitis, aiding clinicians in making more accurate diagnoses and supporting the development of treatment strategies.