{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T14:51:13Z","timestamp":1774968673883,"version":"3.50.1"},"reference-count":29,"publisher":"Ubiquity Press, Ltd.","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TOHM"],"abstract":"<jats:p>Background: Scrub typhus is a major rickettsial infection in Asia, occasionally presenting with movement disorders due to central nervous system involvement. This systematic review aimed to summarize their frequency, spectrum, diagnostic profile, treatment, and outcomes.\nMethods: A comprehensive search of PubMed, Embase, Scopus, and Google Scholar was conducted up to August 2025. All case reports, case series, and cohort studies reporting movement disorders associated with scrub typhus were included. Data were extracted and analyzed descriptively. The protocol was prospectively registered with PROSPERO under the identifier PROSPERO 2025 CRD420251156525.\nResults: Across 55 published cases, scrub typhus\u2013associated movement disorders occurred predominantly in young adults (median age 28 years), with a male predominance (61.8%). Opsoclonus and related ocular motor disorders were the most frequent manifestations (41.8%), followed by cerebellar syndromes (34.5%), parkinsonism (12.7%), myoclonus (7.3%), and rare presentations such as ballismus, dystonia, opisthotonus, and akinetic mutism (7.3%). Associated neurological signs included cerebellar involvement (32.7%), altered sensorium (25.5%), extrapyramidal features (21.8%), and seizures (10.9%). In cohort studies including 2437 patients, 63 (2.6%) developed movement disorders, with opsoclonus\u2013myoclonus seen in 22 (34.9%), ataxia in 17, myoclonus in 11 (17.4%), and extrapyramidal features in 25 (39.6%). Rare hyperkinetic manifestations such as hemiballismus and choreoathetoid movements were occasionally reported. Most patients had favorable outcomes, with complete recovery in 38 (69.1%), near-complete recovery in 6 (10.9%), partial recovery in 5 (9.1%), and death in 1 (1.8%).\nConclusions: Movement disorders in scrub typhus, though uncommon, display a wide clinical spectrum and are often reversible.<\/jats:p>","DOI":"10.5334\/tohm.1148","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:31:57Z","timestamp":1774963917000},"page":"22","source":"Crossref","is-referenced-by-count":0,"title":["Movement Disorders in Scrub Typhus: A Systematic Review"],"prefix":"10.5334","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0044-7083","authenticated-orcid":false,"given":"Ravindra Kumar","family":"Garg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1483-2233","authenticated-orcid":false,"given":"Shweta","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3195-0220","authenticated-orcid":false,"given":"Amita","family":"Jain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8285-3936","authenticated-orcid":false,"given":"Ritu","family":"Karoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5795-8485","authenticated-orcid":false,"given":"Vinay","family":"Suresh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0786-9107","authenticated-orcid":false,"given":"Sanjay","family":"Singhal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3285","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"key20260331133151_B1","unstructured":"Centers for Disease Control and Prevention. Clinical overview of scrub typhus. Atlanta, GA: CDC; May 15, 2024. Available at: https:\/\/www.cdc.gov\/typhus\/hcp\/clinical-overview\/clinical-overview-of-scrub-typhus.html. Accessed October 2, 2025."},{"issue":"11","key":"key20260331133151_B2","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1056\/NEJMoa2408645","article-title":"Incidence of Scrub Typhus in Rural South India","volume":"392","year":"2025","journal-title":"N Engl J Med"},{"issue":"1","key":"key20260331133151_B3","article-title":"Global seroprevalence of scrub typhus: a systematic review and meta-analysis","volume":"14","year":"2024","journal-title":"Sci Rep"},{"issue":"5","key":"key20260331133151_B4","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/QCO.0000000000001135","article-title":"Neurological complications of scrub typhus","volume":"38","year":"2025","journal-title":"Curr Opin Infect Dis"},{"issue":"8","key":"key20260331133151_B5","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s11910-022-01215-5","article-title":"Neurological Manifestations of Scrub Typhus","volume":"22","year":"2022","journal-title":"Curr Neurol Neurosci Rep"},{"issue":"11","key":"key20260331133151_B6","article-title":"Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality","volume":"16","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"key20260331133151_B7","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/tmi.14114","article-title":"Scrub typhus-associated movement and gait disorders: A systematic review with principal component analysis and in silico mechanistic modelling","volume":"30","year":"2025","journal-title":"Trop Med Int Health"},{"issue":"1","key":"key20260331133151_B8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.4103\/ni.ni_139_22","article-title":"Neurological Manifestations of Scrub Typhus: The Clinical Spectrum, Determinants, and Outcome","volume":"73","year":"2025","journal-title":"Neurol India"},{"issue":"6","key":"key20260331133151_B9","doi-asserted-by":"crossref","first-page":"849","DOI":"10.4103\/aian.aian_739_21","article-title":"Neurological Facets of Scrub Typhus: A Comprehensive Narrative Review","volume":"24","year":"2021","journal-title":"Ann Indian Acad Neurol"},{"key":"key20260331133151_B10","unstructured":"Garg RK, Pandey S, Jain A, Suresh V, Singhal S. Movement Disorders Associated with Scrub Typhus: A Systematic Review. PROSPERO. 2025;CRD420251156525. Available at: https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251156525. Accessed September 30, 2025."},{"key":"key20260331133151_B11","article-title":"Eschar: A Very Important Clue in Diagnosis of Scrub Typhus","year":"2025","journal-title":"QJM"},{"issue":"3","key":"key20260331133151_B12","doi-asserted-by":"crossref","first-page":"368","DOI":"10.4269\/ajtmh.2010.09-0233","article-title":"Diagnosis of scrub typhus","volume":"82","year":"2010","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"key20260331133151_B13","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1586\/14787210.2014.974559","article-title":"Diagnosis of scrub typhus","volume":"12","year":"2014","journal-title":"Expert Rev Anti Infect Ther"},{"key":"key20260331133151_B14","unstructured":"The Movement Disorder Society. About movement disorders: clinical information, resources, tools, and education about common movement disorders. Available at: https:\/\/www.movementdisorders.org\/MDS\/About\/Movement-Disorder-Overviews.htm. Accessed September 30, 2025."},{"issue":"2","key":"key20260331133151_B15","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1136\/bmjebm-2017-110853","article-title":"Methodological quality and synthesis of case series and case reports","volume":"23","year":"2018","journal-title":"BMJ Evid Based Med"},{"issue":"1","key":"key20260331133151_B16","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ajog.2020.04.013","article-title":"Coronavirus disease 2019 during pregnancy: a systematic review of reported cases","volume":"223","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"key20260331133151_B17","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jocn.2012.01.047","article-title":"Scrub typhus associated with transient parkinsonism and myoclonus","volume":"20","year":"2013","journal-title":"J Clin Neurosci"},{"issue":"12","key":"key20260331133151_B18","first-page":"371","article-title":"Dancing eyes and dancing feet in scrub typhus","volume":"8","year":"2015","journal-title":"Australas Med J"},{"issue":"2","key":"key20260331133151_B19","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4103\/aian.AIAN_198_18","article-title":"Scrub Typhus-Associated Opsoclonus: Clinical Course and Longitudinal Outcomes in an Indian Cohort","volume":"22","year":"2019","journal-title":"Ann Indian Acad Neurol"},{"issue":"3","key":"key20260331133151_B20","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1093\/clinids\/24.3.436","article-title":"Central nervous system involvement in patients with scrub typhus","volume":"24","year":"1997","journal-title":"Clin Infect Dis"},{"key":"key20260331133151_B21","article-title":"Brain transcriptomics reveal the activation of neuroinflammation pathways during acute Orientia tsutsugamushi infection in mice","volume":"14","year":"2023","journal-title":"Front Immunol"},{"issue":"5","key":"key20260331133151_B22","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.jinf.2014.06.018","article-title":"Increased endothelial and macrophage markers are associated with disease severity and mortality in scrub typhus","volume":"69","year":"2014","journal-title":"J Infect"},{"issue":"3","key":"key20260331133151_B23","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.clineuro.2010.11.007","article-title":"Scrub typhus meningo-encephalitis with focal neurologic signs and associated brain MRI abnormal findings: literature review","volume":"113","year":"2011","journal-title":"Clin Neurol Neurosurg"},{"issue":"4","key":"key20260331133151_B24","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.4049\/jimmunol.1701219","article-title":"Dysregulated Th1 Immune and Vascular Responses in Scrub Typhus Pathogenesis","volume":"200","year":"2018","journal-title":"J Immunol"},{"issue":"19","key":"key20260331133151_B25","doi-asserted-by":"crossref","first-page":"7981","DOI":"10.1073\/pnas.0611553104","article-title":"The Orientia tsutsugamushi genome reveals massive proliferation of conjugative type IV secretion system and host-cell interaction genes","volume":"104","year":"2007","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"10","key":"key20260331133151_B26","article-title":"Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses","volume":"14","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"key20260331133151_B27","article-title":"Metabolic responses to Orientia tsutsugamushi infection in a mouse model","volume":"9","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"key20260331133151_B28","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.micpath.2017.04.012","article-title":"Nitric oxide enhanced the growth of an obligated intracellular bacterium Orientia tsutsugamushi in murine macrophages","volume":"107","year":"2017","journal-title":"Microb Pathog"},{"issue":"1","key":"key20260331133151_B29","article-title":"Scrub typhus association with autoimmune biomarkers and clinical implications","volume":"19","year":"2025","journal-title":"PLoS Negl Trop Dis"}],"container-title":["Tremor and Other Hyperkinetic Movements"],"original-title":[],"link":[{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/download\/1148\/2187","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/download\/1148\/2188","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/download\/1148\/2189","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/download\/1148\/2190","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/download\/1148\/2191","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/download\/1148\/2192","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/download\/1148\/2187","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:35:42Z","timestamp":1774964142000},"score":1,"resource":{"primary":{"URL":"https:\/\/account.tremorjournal.org\/index.php\/up-j-tohm\/article\/view\/1148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":29,"URL":"https:\/\/doi.org\/10.5334\/tohm.1148","relation":{},"ISSN":["2160-8288"],"issn-type":[{"value":"2160-8288","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}