Dengue with Scrub Typhus Coinfection in Northern India

Abstract

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.

Clinical and Laboratory Profile of Admitted Patients Presenting With Febrile Illness Due to Dengue and Scrub Typhus Coinfection From a Tertiary Care Hospital in South Rajasthan, India

“…in which patients with coinfection had pallor compared to those with dengue and scrub typhus alone. A study conducted by Visha Singh et al [12] noted that their patients with coinfection had no pallor, this finding is dissimilar to our study.…”