Bilateral abducens nerve palsy in scrub meningoencephalitis in a ten year child: A rarity

Abstract

Scrub typhus is caused by Orientia tsutsugamushi from the typhus fever group. Transmitted by chiggers (mite larvae) Leptobrombidium deliensis in India, when humans trespass mite islands, vectors are constantly fed with the bacilli by reservoirs (rodents and birds). It can also be transmitted transovarially and kept in a constant vicious cycle. The disease is often overlooked due to the non-specific clinical manifestations and lack of specific diagnostic facilities making it a challenge diagnostically and therapeutically. Disease manifestations range from fever, rash, lymphadenopathy, eschar to severe pneumonia and neuropsychiatric complications causing morbidity and mortality. Here we describe a case of a ten-year-old child with bilateral abducens nerve palsy caused by scrub meningoencephalitis, which completely resolved in eight weeks with doxycycline therapy.