{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:58:42Z","timestamp":1790657922219,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Scrub typhus is an important cause of acute febrile illness in Nepal and can rarely present with meningoencephalitis and multiorgan involvement. We report a 32\u2010year\u2010old female farmer from rural Nepal who presented during the monsoon season with high\u2010grade fever, myalgia, vomiting, and an eschar following an unidentified forest bite. She developed meningismus, hypotension, mild acute respiratory distress syndrome, and transaminitis. Cerebrospinal fluid showed lymphocytic pleocytosis and elevated protein, while bacterial culture, acid\u2010fast staining, and GeneXpert were negative. Serum scrub typhus IgM was positive, whereas\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Brucella abortus<\/jats:italic>\n                    <\/jats:styled-content>\n                    IgM was borderline positive. CSF PCR for both pathogens was negative. Based on the characteristic eschar, clinical presentation, CSF findings, epidemiological exposure, and exclusion of alternative diagnoses, scrub typhus meningoencephalitis was considered the most likely diagnosis. She improved with doxycycline\u2010based therapy and achieved complete neurological recovery. This case highlights the challenges of diagnosing scrub typhus in resource\u2010limited settings despite negative PCR.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.73650","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:36:51Z","timestamp":1790656611000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Scrub Typhus Meningoencephalitis With Concurrent Brucellosis in Rural Nepal: Diagnostic Challenges With Negative\n                    <scp>PCR<\/scp>\n                    in a Low\u2010Resource Setting"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9704-5883","authenticated-orcid":false,"given":"Pashupati","family":"Pokharel","sequence":"first","affiliation":[{"name":"Institute of Medicine, Tribhuvan University  Kathmandu Nepal"},{"name":"Sukraraj Tropical and Infectious Disease Hospital  Teku, Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diwash","family":"Rai","sequence":"additional","affiliation":[{"name":"Patan Academy of Health Sciences  Lalitpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7617-5200","authenticated-orcid":false,"given":"Milan","family":"Bajracharya","sequence":"additional","affiliation":[{"name":"Sukraraj Tropical and Infectious Disease Hospital  Teku, Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1710-8926","authenticated-orcid":false,"given":"Abhikshya","family":"Basnet","sequence":"additional","affiliation":[{"name":"Sukraraj Tropical and Infectious Disease Hospital  Teku, Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2941-8307","authenticated-orcid":false,"given":"Bimal Sharma","family":"Chalise","sequence":"additional","affiliation":[{"name":"Sukraraj Tropical and Infectious Disease Hospital  Teku, Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6921-8014","authenticated-orcid":false,"given":"Arati","family":"Baskota","sequence":"additional","affiliation":[{"name":"Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7069-2979","authenticated-orcid":false,"given":"Andrew B.","family":"Trotter","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine University of Illinois Chicago College of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"11","key":"e_1_2_15_2_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006062","article-title":"A Review of the Global Epidemiology of Scrub Typhus","volume":"11","author":"Xu G.","year":"2017","journal-title":"PLoS Neglected Tropical Diseases"},{"key":"e_1_2_15_3_1","unstructured":"O. 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K.Panda \u201cScrub Typhus \u201d (2024) https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK558901\/."},{"issue":"10","key":"e_1_2_15_4_1","doi-asserted-by":"crossref","first-page":"5022","DOI":"10.1097\/MS9.0000000000001259","article-title":"Epidemiology, Clinical Characteristics, Diagnosis, and Complications of Scrub Typhus Infection in Nepal: A Systematic Review","volume":"85","author":"Lamichhane P.","year":"2023","journal-title":"Annals of Medicine and Surgery"},{"issue":"1","key":"e_1_2_15_5_1","doi-asserted-by":"crossref","first-page":"10895","DOI":"10.1038\/s41598-024-61555-9","article-title":"Global Seroprevalence of Scrub Typhus: A Systematic Review and Meta\u2010Analysis","volume":"14","author":"Dasgupta S.","year":"2024","journal-title":"Scientific Reports"},{"issue":"12","key":"e_1_2_15_6_1","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1586\/14787210.2014.974559","article-title":"Diagnosis of Scrub Typhus","volume":"12","author":"Janardhanan J.","year":"2014","journal-title":"Expert Review of Anti\u2010Infective Therapy"},{"issue":"2","key":"e_1_2_15_7_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1093\/trstmh\/trx017","article-title":"Clinical Manifestations of Scrub Typhus","volume":"111","author":"Rajapakse S.","year":"2017","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"issue":"2","key":"e_1_2_15_8_1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4103\/0019-5049.111835","article-title":"Scrub Typhus","volume":"57","author":"Rapsang A. 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A.","year":"2019","journal-title":"Polish Journal of Microbiology"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73650","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73650","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:37:08Z","timestamp":1790656628000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":18,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/ccr3.73650"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73650","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-08-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73650"}}