Scrub typhus (Orientia tsutsugamushi)-associated intracranial infection: a case report and review of diagnostic and therapeutic challenges

Intracranial infections caused by Orientia tsutsugamushi (O. tsutsugamushi), the causative agent of scrub typhus, are rare but potentially fatal. This case report describes a 45-year-old male patient presenting with persistent fever, headache, altered mental status, and skin lesions. High-throughput sequencing of cerebrospinal fluid confirmed O. tsutsugamushi, while respiratory samples detected Pseudomonas aeruginosa and Aspergillus fumigatus, suggesting a mixed bacterial and fungal infection. After timely adjustment of anti-infective treatment, the patient's condition significantly improved. This case emphasizes the importance of early recognition and molecular diagnosis in the management of complex infections, and highlights the key role of typical signs, such as erythema on the lower back, in the early diagnosis in endemic areas.