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Clinical and laboratory findings in scrub typhus associated Guillain-Barré syndrome in South Korea

Authors
Yoon, Byeol-AKim, Sun-YoungKim, JuhyeonSeok, Jung ImSeok, Jin MyoungLee, SukyoonKim, Jong KukOh, Seong-il
Issue Date
Jan-2024
Publisher
WILEY
Keywords
Guillain-Barre syndrome; Orientia tsutsugamushi; rickettsia; scrub typhus; tsutsugamushi disease
Citation
JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM
Indexed
SCIE
SCOPUS
Journal Title
JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM
URI
https://scholarworks.gnu.ac.kr/handle/sw.gnu/69698
DOI
10.1111/jns.12614
ISSN
1085-9489
1529-8027
Abstract
Background and Aims: Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barre syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. Methods: Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected. Results: Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points. Interpretation: Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.
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