SkiptomaincontentYouarehereHomeArchiveVolume2018, IssueMeningitisduetoscrubtyphus:theimportanceofadifferentialdiagnosisinanendemicareaEmailalertsArticleTextArticlemenuArticleTextArticleinfoCitationToolsShareRapidResponsesArticlemetricsAlertsPDFUnusualpresentationofmorecommondisease/injuryCASEREPORTMeningitisduetoscrubtyphus:theimportanceofadifferentialdiagnosisinanendemicareahttp://orcid.org/0000-0003-2659-3425SudeepAdhikari1,BuddhiPaudyal1,KeshavRajSigdel1,http://orcid.org/0000-0003-3511-2654BuddhaBasnyat21DepartmentofInternalMedicine,PatanAcademyofHealthSciences,Kathmandu,Nepal2OxfordUniversityClinicalResearchUnit,PatanHospital,Kathmandu,NepalCorrespondencetoProfessorBuddhaBasnyat,buddhabasnyat{at}gmail.comSummaryApatientwithfeverandneckstiffnesswastreatedaspartiallytreatedbacterialmeningitisbasedonhistory,examinationandcerebrospinalfluidanalysis.Afterinitialimprovementwithceftriaxone,vancomycinanddexamethasone,symptomsrecurred.Feverresolvedpromptlyaftertreatmentwasstartedwithdoxycycline,whenscrubtyphusimmunoglobulinMtestcamepositive.Meningitisisawell-knowncomplicationofscrubtyphus.However,scrubtyphusisseldomconsideredinthedifferentialdiagnosisofmeningitisintheIndiansubcontinent.Earlydiagnosisandpromptinstitutionofdoxycyclinetherapymayleadtoearlycureofscrubtyphusevenwhenfeaturesofmeningitissupervene.However,ceftriaxonewhichiscommonlyusedtotreatbacterialmeningitisissuboptimalinthetreatmenwgt36tofscrubtyphus.meningitistropicalmedicine(infectiousdisease)http://dx.doi.org/10.1136/bcr-2018-224499StatisticsfromAltmetric.commeningitistropicalmedicine(infectiousdisease)ViewFullTextFootnotesContributorsBBconceivedthewriteup.SAwrotethefirstdraft.Allauthorstookcareofthepatient.Allauthorsreadandcontributedtothefinaldraft.FundingTheauthorshavenotdeclaredaspecificgrantforthisresearchfromanyfundingagencyinthepublic,commercialornot-for-profitsectors.CompetinginterestsNonedeclared.PatientconsentObtained.ProvenanceandpeerreviewNotcommissioned;externallypeerreviewed.RequestPermissio