case of scrub typhus encephalopathy

Scrub typhus, caused by Orientia tsutsugamushi, is prevalent in the tropical areas like South-East and Far East Asia. A seven-year-old Indian boy who had recently returned from India, presented with fever, headache, vomiting and convulsions refractory to anticonvulsants and multiple antimicrobials. He was diagnosed as a case of Scrub Typhus by Weil-Felix test. He responded well to a ten day course of chloramphenicol. A huge population in Kuwait travels to and from the areas endemic for Scrub typhus. A clinical suspicion is prudent in all such cases presenting with a pyrexia of unknown origin. In cases with involvement of the central nervous system, chloramphenicol should be the first choice of treatment, as it penetrates the blood brain barrier well