Possible Scrub Typhus Coinfections in Thai Agricultural Workers Hospitalized With Leptospirosis

Abstract

Possible coinfections with Orientia tsutsugamushi the causative agent of scrub typhus, were prospectively evaluated in rice farmers hospitalized with leptospirosis in Northeast Thailand. Of 22 adults with leptospirosis diagnosed by the microscopic agglutination test, 9 also had serologic evidence of scrub typhus. Of 9 individuals with possible coinfections, 5 had signs or symptoms typical of scrub typhus and atypical of leptospirosis. Patients who appeared to have mixed infections had significantly higher median platelet counts and significantly lower median serum bilirubin and creatinine concentrations (P < 0.05, Mann-Whitney U test) than did individuals with leptospirosis alone. One patient with serologic evidence of scrub typhus and leptospirosis was treated only with penicillin, to which scrub typhus is not sensitive. Respiratory distress worsened during therapy, and the patient died of respiratory failure. Physicians should consider the possibility of scrub typhus infection in leptospirosis patients who respond poorly to treatment or who have atypical disease manifestations.

Persistence ofOrientia tsutsugamushiin Humans

“…"Late relapse", i.e., recurrence of scrub typhus several months or years after the initial O. tsutsugamushi infection, is surely possible. Reactivation of dormant O. tsutsugamushi infection is documented in mice after inoculation of heterologous strain of O. tsutsugamushi or treatment with cyclophosphamide (14); in humans, coinfection of scrub typhus and leptospirosis (22), especially in patients not accompanied with eschar, may represent reactivation of scrub typhus triggered by leptospirosis.…”

Knowledge, Attitude and Practices towards Leptospirosis among Lakeshore Communities of Calamba and Los Baños, Laguna, Philippines

“…Agricultural workers engaged in crop farming, fish culture, and livestock raising and slaughtering are among the groups at high risk of acquiring leptospirosis because their work entails close contact with infected animals or urine-contaminated water and soil [13][14][15][16][17][18]. Moreover, agricultural workers typically lack awareness and basic knowledge of leptospirosis, hence making them more vulnerable to infection [19].…”

Evaluation of Four Whole-Cell Leptospira -Based Serological Tests for Diagnosis of Urban Leptospirosis

“…Misdiagnosis is a major problem in regions where other causes of undifferentiated febrile illness and hemorrhagic fever are endemic (12,14,17,23,37,39). The microscopic agglutination test (MAT), the standard for diagnosis confirmation, is impractical for clinical decision making since it requires analysis of paired serum samples for proper interpretation and a reference laboratory to perform dark-field microscopy (9,18).…”