# MRI Brain Findings and Clinical Spectrum of Children With Typhus-Positive Acute Encephalitis Syndrome: Associations With Neurological Sequelae

## TL;DR

This study examines MRI brain findings and clinical outcomes in children with typhus-related encephalitis in India, highlighting neurological complications.

## Contribution

The study identifies MRI brain abnormalities and their association with neurological sequelae in children with typhus-positive acute encephalitis syndrome.

## Key findings

- Scrub typhus is a leading cause of acute encephalitis syndrome in North Indian children.
- MRI showed multiple lesions in brain regions like the cerebral hemispheres and midbrain in 27.1% of patients.
- Shock, myocarditis, and respiratory failure were significantly linked to neurological sequelae at discharge.

## Abstract

Background

Scrub typhus, caused by Orientia tsutsugamushi through chigger bites, is a significant cause of acute encephalitis syndrome (AES) in children in Southeast Asia.

Materials and methods

This cross-sectional study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital in Gorakhpur district, Uttar Pradesh, India, over one year, from October 2021 to September 2022.

Result

Among 274 AES patients screened, 144 (52.55%) tested positive for scrub typhus via enzyme-linked immunosorbent assay (ELISA). Half of the affected patients were aged 1-5 years. MRI abnormalities were found in 29 (27.10%) patients, showing multiple patchy lesions in both cerebral hemispheres, caudate nucleus, basal ganglia, thalamus, and the midbrain. Significant associations were identified between shock (p=0.00001), myocarditis (p=0.002), refractory seizure (p=0.001), respiratory failure (p=0.001), and the development of sequelae (p=0.0003) at discharge.

Conclusion

Scrub typhus is the leading cause of AES in North India. Abnormal MRI findings have a significant association with complications and sequelae at discharge in AES patients.