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Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 50-51

Coinfection with leptospirosis and scrub typhus

1 Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
2 Department of Radio-diagnosis, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India

Date of Web Publication12-Feb-2018

Correspondence Address:
Manoj Kumar Choudhary
Assistant Professor, Department of Gen. Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar
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Leptospirosis and scrub Typhus are zoonoses with worldwide distribution. Both are important causes of acute febrile illness. The clinical presentation is wide for both disease ranging from mild to fatal. A diagnosis of confection with leptospirosis and scrub typhus may be underdiagnosed due to lack of clinical suspicion. we are reporting a case of confection with leptospirosis and scrub typhus who presented with fever, breathlessness and altered sensorium at emergency and admitted under general medicine department of Indira Gandhi institute of medical science, Patna. Patient was initially treated empirically as a case of acute febrile illness with encephalopathy, later on specific therapy started after serological confirmation of leptospirosis and scrub typhus and the patient responded very well to the therapy without any sequelae during hospital stay and follow up.

Keywords: Leptospirosis, Scrub Typhus, Coinfection

How to cite this article:
Choudhary MK, Kumar A, kumar P, Mishra AK, Saha KK, Deepankar P, Suman S K, Kumar A. Coinfection with leptospirosis and scrub typhus. J Indira Gandhi Inst Med Sci 2018;4:50-1

How to cite this URL:
Choudhary MK, Kumar A, kumar P, Mishra AK, Saha KK, Deepankar P, Suman S K, Kumar A. Coinfection with leptospirosis and scrub typhus. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2022 Aug 10];4:50-1. Available from: http://www.jigims.co.in/text.asp?2018/4/1/50/302986

  Introduction : Top

Leptospirosis, a spirochetal infection, is an important zoonosis with a worldwide distribution[1]. The disease has high incidence and prevalence in both developed and developing countries [2]. Rodents, domestic animals serve as reservoirs and contact with infected urine, tissues and water form the route of transmission in leptospirosis. Systemic features are common in the acute bacteremia phase of the disease, whereas ocular features are common, in the immunological phase[3].

Scrub typhus is a rickettsiosis caused by Orientia tsutsugamushi. It is transmitted by a chigger bite[4]. It is widely distributed in the Asia-Pacific region. Major symptoms include fever, headache, inoculation eschar and lymphadenopathy. The clinical manifestations of both diseases can be nonspecific and diagnosis can be difficult due to lack of a rapid diagnostic test and an inadequate level of clinical suspicion.

  Case History : Top

A 25 years old man was admitted at department of general medicine, Indira Gandhi institute of medical science, Patna with complaints of fever, breathlessness, and altered sensorium for 5 days. On examination the patient was febrile, Tachypneic, confused [Glasgow coma scale E3V4M6], Pulse rate 110 beats per minute, Regular in rhythm and Blood Pressure was 90/60mmHg. An Eschar was present just above the knee joint in both of the legs. Cardiac examination and abdominal examination was normal in limit. There was bilateral crepitation sound present on chest examination. On central nervous system examination, the patient was confused with normal papillary reflexes and bilateral upward planter reflexes.

Investigation revealed Hb-10.4mg/dl, Leucocytes 10100/cmm, Platelet count - 3.36lac/cumm, N55%, L45%, E03%, B0%, SGPT/SGOT-52/60 IU/L, Bilirubin-Normal, Serum total protein and serum albumin decreased. Lumber puncture was performed because of altered sensorium and CSF examination revealed Protein 55mg/dl, CSF-Sugar- 43mg/dl, ADA-11.60. ABG was showing Type 1 respiratory failure, MRI of brain was normal. X-ray chest revealed increased bronco vascular marking and prominent bilateral lung field initially. Later on, bilateral ground glass appearance was seen in Middle and lower Lung fields. Contrast enhanced computed tomography of chest showed bilateral perihilar patch, ground glass opacities and septal thickening extending into lower zone. Ultrasound of abdomen showed mild hepatomegaly, contracted gallbladder and few enlarged lymph nodes along right iliac fossa, Echocardiography was normal. Serological test for Scrub Typhus IgM was reactive and Leptospira IgM antibody was also positive.

Bilateral Perihilar patchy ground glass opacities with septal thickening seen in contrast enhanced computed tomography of chest.

Treatment- patient was diagnosed as a case of febrile illness with encephalopathy and respiratory distress. Patient was treated with antibiotics, antimalarial and antiviral drugs and other supportive therapy initially. After the serology report of leptospirosis and scrub typhus positivity we revised the treatment and started Injection doxycycline, and continued injection ceftriaxone and hold the antimalarial and antiviral drugs. We continued others supportive therapy like oxygen inhalation, intravenous fluid, antipyretic drugs etc. Fever and General condition of patient was improved on 3 days of admission. Patient was discharged on day 7, radiological improvement was also obvious in sequential chest X-Ray. Patient came to OPD medicine for follow up after 5 days and patient was asymptomatic with healed skin lesion.

  Discussion : Top

Scrub typhus is an important cause of acute febrile illness with a yearly incidence of around one million[5]. Leptospirosis is another important cause of febrile illness with a wide spread global distribution6. Scrub typhus and Leptospirosis are common serious infection that can be fatal if not treated early. The clinical manifestation of leptospirosis and scrub typhus can be nonspecific and both disease can cause fever headache, skin rash, myalgia and conjunctiva suffusion. In severe cases, both disease evolve eventually leading to multiple organ dysfunction including pneumonitis, encephalitis, myocarditis, acute renal failure, hepatitis and disseminated intravascular coagulopathy. Clinician should therefore, be vigilant for the possibility of dual infection and exposure history highly suggestive of either leptospirosis or scrub typhus. It must be suspected in all cases of undifferentiated acute febrile illness along with other common disease like malaria, dengue fever and typhoid fever.

  Conclusion : Top

Both leptospirosis and Scrub typhus are neglected tropical disease with similar presenting features. Therefore, making a distinction between two diseases is difficult on clinical ground alone. Further study is needed to clarify whether this apparently rare confection is actually more common but under diagnosed due to lack of clinical suspicion.

  References Top

Daher Ede F, Abreu KL, da Silva Junior GB. Leptospirosis-associated acute kidney injury. J Bras Nefrol 2010;32:400-407.  Back to cited text no. 1
Vijachari P, Sugunan AP, Shriram AN Leptospirosis: an emerging global public health problem. J Bio Sci 2008;33: 557-69.  Back to cited text no. 2
Rathinam SR , Ocular manifestations of leptospirosis. J Postgrad Med 2005;51:189-194.  Back to cited text no. 3
Mandell GL, Bennett JE, Dolin R: Principles and practice of infectious diseases, 6th ed., Pennsylvania: Churchill Livingstone, 2005; 2789-2795  Back to cited text no. 4
Paris DH, Shelite TR, Day NP, Warker DH unresolved problems related to Scrub typhus: a seriously neglected life threating disease.AMJ Trop med Hyg 2013;89:301-307.  Back to cited text no. 5
HakeDA,levett PN leptospirosis in india; curr top microbial immunol 2015;387:65-97.  Back to cited text no. 6


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