Main Article Content
Background: Amongst the many vector and water-borne diseases prevalent in tropics, dengue occupies a prominent place. Dengue epidemics are frequent and at times, during such epidemic, coinfections may occur causing diagnostic dilemmas.
Case Report: A 36 years old lady, from a rural background, presented during the 2019 dengue epidemic with fever, vomiting, and non-colicky abdominal pain. The evaluation showed hepatosplenomegaly, leukocytosis, and thrombocytopenia. The investigations confirmed the diagnosis and she was treated conservatively as a case of dengue with warning signs. A longer than anticipated duration of fever and clinical deterioration prompted reassessment, which revealed the presence of an eschar over the right upper thigh. The Weil-Felix test using Proteus OX-K stain was positive at a titer of 1:320. Following treatment with oral doxycycline, she showed rapid defervescence and clinical improvement.
Conclusions: Coinfection with scrub typhus is rare with dengue. If left untreated, it adversely affects the outcome. The key to diagnosing such coinfections includes a high index of suspicion, repeated clinical examination, and the knowledge of local endemicity.
Kelly DJ, Fuerst PA, Ching WM, Richards AL. Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis. 2009;48(3):S203-230.
Rapmund G. Rickettsial diseases of the Far East: New perspectives. J Infect Dis. 1984;149:330-8.
Mahajan SK. Scrub typhus. J Assoc Physicians India. 2005;53:954–8.
Sinha P, Gupta S, Dawra R, Rijhawan P. Recent outbreak of scrub typhus in North Western Part of India. Indian J Med Microbiol. 2014;32:247-250.
Kim DM, Won KJ, Park CY, Yu KD, Kim HS, Yang TY, et al. Distribution of eschars on the body of scrub typhus patients: A prospective study. Am J Trop Med Hyg. 2007;76:806-809.
Peter JV, Sudarsan TI, Prakash JA, Varghese GM. Severe scrub typhus infection: Clinical features, diagnostic challenges and management. World J Crit Care Med. 2015;4:244–50.
Sapkota S, Bhandari S, Hamal R. Dengue and scrub typhus coinfection in a patient presenting with febrile illness. Case Reports in Infectious Diseases; 2017. Article ID: 6214083.
Basheer A, Iqbal N, Mookkappan S, Anitha P, Nair S, Kanungo R, Kandasamy R. Clinical and laboratory characteristics of dengue-Orientia tsutsugamushi co-infection from a Tertiary Care Center in South India. Mediterr J Hematol Infect Dis. 2016;8(1):e2016028.
Watt G, Jongsakul K, Chouriyagune C, Paris R. Differentiating dengue virus infec-tion from scrub typhus in Thai adults with fever. Am J Trop Med Hyg. 2003;68:536-8.