The present study is the first report of co-infection of scrub typhus with leptospirosis from Northeast India. Medical officers in this region should take scrub typhus and leptospirosis in their differential diagnosis of patients with PUO for early diagnosis and effective treatment.

As clinical symptoms overlap with other viral/bacterial infections, scrub typhus infection should be considered in differential diagnosis of any acute febrile illness in this part of the country. In view of the high prevalence, empirical therapy of doxycycline/azithromycin may be done in cases of undiagnosed fever. Active surveillance has to be done to understand exact magnitude, epidemiological aspects, and distribution of vector and disease of this reemerging neglected tropical disease.

Introduction: Globally enteric adenovirus has become the second leading cause of viral diarrhea. Present investigation was undertaken to understand the adenoviral etiology of diarrhea among hospitalized children in Assam, northeast India. Materials and methods: Over a period of two years (2013-2015), 455 faecal samples were collected from hospitalized children aged <5 years with diarrhea from Assam, northeast India for screening of rotavirus antigen. A total of 238 samples were rotavirus antigen negative and are screened for adenovirus antigen by ELISA and followed by PCR. Results: Present investigation revealed enteric adenovirus infection in hospitalized children <5 years to be 10.9% (26/238). Prevalence was higher among infants (16.6%) and females (15.1%). Moreover, severe diarrhea (≥10 times) 14.9% (P=0.047) and restlessness 50% (P=0.002) is significantly higher in enteric adenovirus infected children. Enteric adenovirus infection was observed sporadically throughout the year; however infection was higher during warmer months (17%) than cooler months (7.3%) (P=0.0001). Adenovirus sequence analysis of the hexon gene showed adenovirus F type-41 to be the predominant serotype circulating in the study region. Analysis of the adenovirus fiber protein of the present study confirmed 15 amino acid deletions from the 15 th repeat motif of the shaft region. Conclusions: Present data demonstrated that enteric adenovirus could be considered an important viral etiological agent for acute gastroenteritis among children in northeast India along with other etiology.

The present study reveals a shift in the serotype dominance in the study region. As serotype shifts and secondary infection with a heterologous DENV serotype are frequently associated with disease severity, there is an urgent need for sustained monitoring of the circulating serotypes and enhanced surveillance operations, especially in the monsoon and post-monsoon periods to prevent large-scale, severe dengue outbreaks in this region.

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