Two Cases of Tsutsugamushi Meningitis

ABSTRACT

Meningitis associated with tsutsugamushi is not a rare disease and simple, effective treatments are available. However, the diagnosis of meningitis is important since it is potentially associated with significant mortality rates. Case 1 : A 47-year-old woman had a headache and high fever with chills for 3 days. She fell into a stupor, and her blood pressure dropped to 80/60 mmHg on the fifth day of admission to the hospital. The patient was treated with 200 mg of doxycycline given intravenously. Case 2 : A 48-year-old woman was admitted with a 7-day history of fever with chills, severe headache, vomiting, and a generalized non-pruritic erythematous maculopapular rash. The patient was treated with 200 mg of doxycycline given orally. CSF examinations revealed predominantly lymphocytic pleocytosis in all cases. The indirect immunofluorescent antibody titer for Orientia tsutsugamushi were 1:20,480 in case 1 and 1:5, 120 in case 2. We report two cases of meningitis associated with tsutsugamuschi disease.