Scrub Typhus, or tsutsugamushi disease is a febrile illness caused by bacteria of the family Rickettsiaceae and named Orientia tsutsugamushi. Recently it has been found to endemic in Subhimalayan region of India.Malaria is highly endemic in rest of India but its prevalence is low in Subhimalayan region because of the altitude. We report a rare case of a patient having coinfection with scrub typhus and malaria

Bellad, A

Dhiman, P

Madhabhavi, I

Panda, P

Raina, R

Sharma, A

English

Cognitive Sciences ePrint Archive

 Case Report
Rare Coinfection of Scrub Typhus and Malaria in Immunocompetent Person
Authors
Ashok Sharma, Professor and Head,
Rajeev Raina, Professor,
Pravesh Dhiman, Senior Resident,
Adarsh, Junior Resident,
Irappa Madhabhavi, Junior Resident,
Prashant Panda, Senior Resident,
Dept. of Medicine, Indira Gandhi Medical College, Shimla
Address for Correspondence
Dr. Prashant Panda,
Dept. of Medicine,
IGMC, Shimla,
Himachal Pradesh, India. 
E-mail: prashantpanda85@gmail.com
Citation
Sharma A, Raina R, Dhiman P, Adarsh, Madhabhavi I, Panda P. Rare Coinfection of Scrub Typhus and Malaria in Immunocompetent 
Person. Online J Health Allied Scs. 2012;11(2):12. Available at URL:http://www.ojhas.org/issue42/2012-2-12.htm
Open Access Archives
http://cogprints.org/view/subjects/OJHAS.html
http://openmed.nic.in/view/subjects/ojhas.html
Submitted:jan 25, 2012; Accepted: May 10, 2012; Published: Jul 25,, 2012
Abstract:  Scrub Typhus,  or  tsutsugamushi  disease is a febrile 
illness caused by bacteria of the family Rickettsiaceae and named 
Orientia tsutsugamushi. Recently it has been found to endemic in 
Subhimalayan region of India.Malaria is highly endemic in rest 
of  India  but  its  prevalence  is  low  in  Subhimalayan  region 
because of the altitude. We report a rare case of a patient having 
coinfection with scrub typhus and malaria.
Key Words: Scrub Typhus; Malaria; Coinfection
Background
Scrub Typhus, or tsutsugamushi disease is a febrile illness caused 
by  bacteria  of  the  family  Rickettsiaceae  and  named  Orientia 
tsutsugamushi.  Recently  it  has  been  found  to  endemic  in 
Subhimalayan region of India.Malaria is highly endemic in rest 
of  India  but  its  prevalence  is  low  in  Subhimalayan  region 
because of the altitude. We report a rare case of a patient having 
coinfection with scrub typhus and malaria.
Case Report
A 47 year old female presented with history of fever of 5 days  
duration,  fever  was  high  grade  documented  around  1030F, 
associated with severe bodyaches. There was no history of any 
yellowish discoloration of eyes, decreased urine output, headache 
& altered sensorium. There was also no history of any travel to 
plains in the preceding past. On examination patient was febrile, 
there  was  conjuctival  suffusion  and  insignificant  axillary 
lymphadenopathy.  Eschar  was  present  on  anterior  abdominal 
wall. Rest of the systemic examination was normal.
On investigation hemoglobin, total count, liver and renal function tests, urine examination and HIV–Elisa were normal. IgM Elisa for 
scrub  thyphus  was  positive.  Patient  was  managed  for  scrub  typhus  infection  with  doxycycline  100  mg  Bid.  Inspite  of  taking 
medications  for  72 hours  patient  was  febrile  ,  so further  work  up for  cause  of  pyrexia  was sent  ,  which  revealed  presence  of 
plasmodium vivax  in  peripheral  smear.  Patient  was started on 
chloroquine  and primaquine after which patient responded and 
discharged on 5th day after admission.
Fig.1: Eschar over the anterior abdominal wall
Discussion
Scrub thypus is a common infection in sub Himalayan region of 
India1 and it is known to occur all over India, including Southern 
India2 . Scrub typhus lasts for 14 to 21 days without treatment.  
Severe infections may be complicated by interstitial pneumonia, 
pulmonary edema, congestive heart failure, circulatory collapse, 
and  a  wide  array  of  signs  and  symptoms  of  central  nervous 
system dysfunction, including delirium, confusion, and seizures. 
1
This work is licensed under a
Creative Commons Attribution-
No Derivative Works 2.5 India License
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 11, Issue 2; Apr-Jun 2012
Death may occur as a result of these complications, usually late 
in the second week of the illness.
By contrast, patients treated with appropriate antibiotics typically 
become  afebrile  within  48  hours  of  starting  therapy  .  This 
response  to  treatment  may be  useful  diagnostically;  failure  of 
defervescence within 48 hours is often considered evidence that 
scrub typhus is not present, and that an alternate diagnosis such 
as malaria or dengue should be considered3.But in Subhimalayan 
region prevalence of malaria is  low and usually not  suspected 
and usually not sought after. For our best of knowledge we are 
reporting  the  first  case  report  from India  citing  coinfection  of 
malaria and scrub typhus. Though the presence of coinfection of 
scrub typhus and malaria has been reported in Thai patients with 
fever4, no such case report has been published from India.
Learning  Points
The importance of this case report is too highlight that we should 
suspect other causes of fever in patients of scrub Typhus who are 
not responding to fever within 48 -72 hours of treatment.
References
1. Sharma A, Mahajan S, Gupta ML, Kanga A and Sharma V. 
Investigation  of  an  Outbreak  of  Scrub  Typhus  in  the 
Himalayan Region of India. Jpn J Infect Dis. 2005;58:208-
210
2. Mathai E, Lloyd G, Cherian E et al. Serological evidence 
for  the  continued  presence  of  human  rickettsioses  in 
southern  India. Annals  of  Tropical  Medicine  and 
Parasitology2001;95:395-398.
3. Sheehy  TW,  Hazlett  D,  Turk  RE  Scrub  typhus.  A 
comparison  of  chloramphenicol  and  tetracycline  in  its 
treatment. Arch Intern Med. 1973;132(1):77.
4. Singhsilarak  T,  Phongtananant  S,  Jenjittikul  M  et  al. 
Possible  acute  coinfections  in  thai  malaria 
patients. Southeast  Asian  J  Trop  Med  Public  
Health2006;37;1-4.
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Rare Coinfection of Scrub Typhus and Malaria in Immunocompetent Person

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Ashok Sharma

Rajeev Raina

Pravesh Dhiman

Adarsh

Irappa Madhabhavi

Prashant Panda

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Rare Coinfection of Scrub Typhus and Malaria in Immunocompetent Person

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