Background:
During the summer-autumn epidemic season, pediatric scrub typhus meningoencephalitis (ST) and enteroviral meningoencephalitis (EV) often present with overlapping clinical manifestations and routine cerebrospinal fluid (CSF) findings, making early differential diagnosis challenging and delaying appropriate treatment. Practical diagnostic strategies based on readily available parameters are lacking.
Objective:
To evaluate whether common clinical and laboratory indicators can differentiate pediatric ST meningoencephalitis from EV meningoencephalitis.
Methods:
This single-center retrospective cohort study included 100 children with ST meningoencephalitis and 160 with EV meningoencephalitis admitted between 2019 and 2023. Clinical features and laboratory parameters from peripheral blood and CSF were compared between groups. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Restricted cubic spline (RCS) models explored dose-response relationships, and decision curve analysis (DCA) evaluated clinical utility.
Results:
The two groups showed substantial overlap in seasonality, onset patterns, and routine CSF parameters. Compared with the EV group, children with ST exhibited stronger systemic inflammation and multisystem involvement, with significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), ferritin, and procalcitonin, and lower platelet count (PLT), fibrinogen, and hemoglobin (all P < 0.001). ALT and ferritin showed the highest discriminatory ability (AUC = 0.946 each), followed by PLT (AUC = 0.915), AST (0.909), fibrinogen (0.887), and procalcitonin (0.842). RCS models demonstrated nonlinear dose-response relationships, and DCA confirmed stable net clinical benefits for ferritin, ALT, and PLT.
Conclusions:
Ferritin, ALT, and PLT are effective and accessible indicators for differentiating pediatric ST from EV meningoencephalitis, particularly in resource-limited epidemic settings.
Keywords:
Children; Differential diagnosis; Enterovirus; Ferritin; Meningoencephalitis; Scrub typhus.