Noida: A 29-year-old man has recovered from a rare, life-threatening insect-borne brain infection after doctors in Noida relied on clinical judgment and aggressive treatment despite the condition going undetected on MRI scans.Diagnosed with Rickettsial meningoencephalitis, he was admitted to a private hospital and placed in intensive care, where ventilator support proved crucial in preventing coma or death. Zoonotic in nature, the bacteria causing the disease are often transmitted by mite larvae called ‘chiggers’. The condition occurs when an infection like scrub typhus spreads to the brain, causing severe inflammation. Its symptoms—fever, confusion and drowsiness—often mimic common illnesses, delaying diagnosis and making timely treatment critical.According to doctors, the patient suffered from fever, confusion and altered behaviour for nearly a week. He was conscious but disoriented, with reduced appetite and increasing drowsiness. He had visited a hospital earlier, where his symptoms were mistaken for alcohol withdrawal. Interestingly, MRI scans of the brain showed no abnormality.But the patient’s neurological condition began to worsen. According to Dr Niraj Kumar, a senior consultant of general medicine at Sharda Hospital, Greater Noida, he spotted a dark, scab-like mark on his abdomen. “The lesion, known as an eschar, is a key indicator of scrub typhus. Blood tests later confirmed that it was an insect-borne infection,” he said.By then, the disease had already spread to his brain, said the doctor. “Although the scans were clear, Severe inflammation and swelling were suspected. Rickettsial meningoencephalitis is a rare and often underdiagnosed condition because its symptoms can resemble those of common viral and bacterial illnesses. In many cases, radiological findings remain normal in the early and critical stages,” Kumar added.The patient also developed complications, including liver dysfunction. As his consciousness declined, he was shifted to the intensive care unit and placed on ventilator support. Doctors initiated aggressive treatment based on clinical judgement, administering a combination of antibiotics, antiviral drugs and high-dose steroids to control the infection and brain inflammation, along with supportive care.After several days in critical condition, his response to treatment improved. He was gradually taken off ventilator, and his orientation and awareness returned. He was later moved out of ICU and continued to recover under close observation. “The patient is currently recovering. The case highlights the importance of early clinical suspicion in tropical infections such as scrub typhus. A small eschar on the skin can be the only visible clue to a potentially fatal disease, and timely treatment, even in the absence of clear MRI findings, can prevent coma, permanent brain damage and death,” the doctor added.
