{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T16:08:48Z","timestamp":1772813328074,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T00:00:00Z","timestamp":1684368000000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>This case report highlights the importance of considering scrub typhus as a differential diagnosis for acute encephalitis with cranial nerve palsy in the region of the tsutsugamushi triangle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Scrub typhus is a zoonotic rickettsiosis caused by the bacterium Orientia tsutsugamushi. This disease is endemic to a region called the tsutsugamushi triangle that extends from Southeast Asia to the Pacific Ocean. We report a 17\u2010year\u2010old girl from western Nepal who presented with fever, headache, vomiting, and altered sensorium, as well as bilateral lateral rectus palsy, dysphagia, regurgitation of food, dysarthria, and left\u2010sided upper motor neuron type facial palsy. Following laboratory and imaging tests, the patient was diagnosed with scrub typhus and was treated successfully with high\u2010dose dexamethasone and doxycycline. This case highlights the importance of considering scrub typhus in the differential diagnosis of encephalitis with cranial nerve palsy, especially in the region of the tsutsugamushi triangle. It also emphasizes the need for timely diagnosis and treatment of scrub typhus to prevent the development of various complications and ensure earlier recovery of patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.7376","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T06:16:59Z","timestamp":1684477019000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A case of acute encephalitis syndrome and cranial nerve palsy secondary to scrub typhus: A rare presentation from Western Nepal"],"prefix":"10.1002","volume":"11","author":[{"given":"Seshkanta","family":"Lamichhane","sequence":"first","affiliation":[{"name":"Bir Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8280-1909","authenticated-orcid":false,"given":"Eliz","family":"Achhami","sequence":"additional","affiliation":[{"name":"Sukraraj Tropical &amp; Infectious Disease Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satyam","family":"Mahaju","sequence":"additional","affiliation":[{"name":"Sukraraj Tropical &amp; Infectious Disease Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rabin","family":"Gautam","sequence":"additional","affiliation":[{"name":"Bir Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amrit","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Bir Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,18]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PNTD.0006062"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/AIAN.AIAN_739_21"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.4269\/AJTMH.16-0086"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3201\/EID2505.180914"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PNTD.0006346"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.4269\/AJTMH.17-0077"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/POSTGRADMEDJ-2022-141812"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PNTD.0008675"},{"issue":"33","key":"e_1_2_12_10_1","first-page":"122","article-title":"Scrub typhus: an emerging neglected tropical disease in Nepal","volume":"14","author":"Upadhyaya BP","year":"2016","journal-title":"J Nepal Health Res Counc."},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/TROPICALMED3010008"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.7759\/CUREUS.28989"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.136074"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1995-7645(12)60036-4"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/DMCN.13197"},{"issue":"8","key":"e_1_2_12_16_1","first-page":"1054","article-title":"Scrub typhus with unusual presentation","volume":"5","author":"Kumar ASP","year":"2014","journal-title":"Int J Prev Med."},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/CLINIDS\/24.3.436"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/J.1749-6632.2003.TB07331.X"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.4103\/JNRP.JNRP_44_17"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.17.2.323-347.2004"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/FCIMB.2021.683017"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.DIAGMICROBIO.2007.09.015"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JOCN.2012.01.047"},{"issue":"4","key":"e_1_2_12_24_1","first-page":"251","article-title":"Scrub typhus\u2010associated acute disseminated encephalomyelitis","volume":"15","author":"Chen PH","year":"2006","journal-title":"Acta Neurol Taiwan."},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.KJMS.2011.10.003"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-9-173"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0066595"},{"issue":"6","key":"e_1_2_12_28_1","first-page":"362","article-title":"Case of tsutsugamushi disease (scrub typhus) presenting with fever and pain indistinguishable from trigeminal neuralgia","volume":"47","author":"Arai M","year":"2007","journal-title":"Rinsho Shinkeigaku."},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/ARCHINTE.1991.00400090051010"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/19418744211016107"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.7376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T08:47:49Z","timestamp":1692434869000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.7376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1002\/ccr3.7376"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.7376","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5]]},"assertion":[{"value":"2023-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e7376"}}