Differentiating scrub typhus meningitis from brucellar meningitis in children: A single-center retrospective study

OBJECTIVE: To investigate the clinical distinctions between scrub typhus meningitis and brucellar meningitis in children, and to identify potential biomarkers with early differential diagnostic value to support clinical decision-making. METHODS: A retrospective analysis was conducted on 13 pediatric patients diagnosed with brucellar meningitis admitted to Kunming Children's Hospital over the past decade. Thirteen cases of scrub typhus meningitis were selected as controls using an age- and sex-matching strategy. The clinical manifestations, laboratory findings, and cerebrospinal fluid (CSF) characteristics were compared between the two groups. Receiver operating characteristic (ROC) curve was employed to assess the diagnostic performance and clinical utility of key biomarkers. RESULTS: The pre-admission fever and duration of fever were significantly shorter in the scrub typhus meningitis group. Laboratory evaluation revealed that serum ferritin, procalcitonin (PCT), C-reactive protein (CRP), and creatinine (Cr) levels were markedly higher in the scrub typhus group compared with the brucellosis group. No statistically significant differences were observed in CSF biochemical parameters. ROC analysis demonstrated that ferritin (AUC = 0.870) and PCT (AUC = 0.846) exhibited the greatest diagnostic accuracy, followed by CRP (AUC = 0.814) and Cr (AUC = 0.799). All patients achieved complete clinical recovery following standardized treatment, with no recurrences or fatalities. CONCLUSIONS: Although scrub typhus meningitis and brucellar meningitis share considerable clinical overlap in children, serum ferritin and PCT levels may represent potential diagnostic signals for early differential diagnosis, warranting validation in larger prospective cohorts. High Ferritin levels or PCT levels may provide preliminary clues toward scrub typhus meningitis. Early recognition and targeted antimicrobial therapy are associated with favorable prognostic outcomes.