Neurological manifestations of Rickettsial infections in children

Background

Neurological manifestations in patients with Rickettsial diaseases are increasingly being reported from various parts of India but still Rickettsial diseases as a cause of central nervous system (CNS) infections are underdiagnosed.

Aim

Main objective of this case series is to report neurological manifestations in patients of Rickettsial diseases so as to increase awareness amongst pediatricians.

Methods

Study design was a retrospective analysis of children (birth to 16 years) hospitalized in Smile Institute of Child Health and Orbit Children Hospital, which are secondary referral centres catering to children in five districts of central India, with diagnosis of Rickettsial disease from August 2014 to July 2015. Diagnosis of Rickettsial infections was made by clinical features, IgM antibodies by ELISA, prompt response to Doxycycline and exclusion of differential diagnoses.

Results

Out of 62 patients, who were diagnosed as having Rickettsial diseases, 51 patients had neurological involvement. Out of 51 patients with diagnosis of Rickettsial disease having symptomatic neurological involvement, 21 (41%) had neurological manifestation as the main presenting feature while remaining presented with non-neurological manifestations of Rickettsial diseases too along with neurological manifestations. Youngest patient was 23 days old neonate. Various neurological manifestations seen were headache (90%), irritability (61%), meningeal signs (21%), altered mental status (23%), seizures (17%), papilloedema (6%), focal neurological deficits (13%), cerebrospinal fluid (CSF) abnormalities (76%) and neuroimaging abnormalities (35%).

Conclusions

Myriads of neurological manifestations were seen with varying range of severity. Pediatricians should be aware of neurological manifestations seen in Rickettsial infections and should have high index of suspicion for Rickettsial diseases in febrile patients having neurological features specially in endemic areas.