Clinical spectrum of uncommon neurological manifestations in scrub typhus:A rural Indian case series

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging zoonotic infection endemic to the Asia-Pacific region including India. It presents with diverse and often nonspecific clinical manifestations, making  diagnosis a challenge . We present three serologically (IgM ELISA) confirmed cases of scrub typhus from rural Tamil Nadu, India, that exhibited distinct neurological symptoms.  Case 1: A 56-year-old male farmer with meningoencephalitis characterised by altered sensorium, neck rigidity, and papilloedema, who achieved complete recovery with doxycycline. Case 2: A 45-year-old woman with acute inflammatory myopathy, severe proximal muscle weakness, and elevated muscle enzymes, requiring combined doxycycline and steroid therapy for full recovery. Case 3: a 39-year-old female rice mill worker who developed bilateral moderately severe sensorineural hearing loss with vestibular symptoms, partially improving with doxycycline. These cases highlight the diverse neurological manifestations of scrub typhus beyond classical presentations, advocating for heightened clinical awareness to reduce morbidity from this re-emerging tropical disease.