Rare concurrent infection with scrub typhus, dengue and malaria in a young female

Tropical infections due to dengue, malaria, leptospira, scrub typhus and many other vector borne diseases are commonly seen in South Asia including Indian subcontinent. These infections have overlapping clinical manifestations and season of presentation. Scrub typhus or tsutsugamushi disease is a febrile illness caused by bacteria Orientia tsutsugamushi of the family Rickettsia. It is being reported from all parts of the Indian subcontinent though it is more prevalent in sub-Himalayan regions of north India 1–2 . Malaria is highly endemic in India 3 . Dengue is prevalent throughout India and outbreaks of dengue have been seen from months of October to December 4 . Although concurrent infections are reported, they are not very common 5–6 . These infections being vector borne diseases, the reason for simultaneous infection can be the same breeding period of the vectors in post-monsoon season. Diagnosis of concurrent infections becomes difficult for a physician leading to delay in institution of appropriate treatment. We hereby report a rare case of a patient having concurrent infection with dengue, malaria and scrub typhus. Case report A 25-yr old female presented with complaints of high grade fever associated with chills and rigors of seven days duration during post-monsoon season. She also complained of headache and generalized myalgias. She noticed yellowish discolouration of eyes and reported progressively worsening shortness of breath over three days before admission to the hospital. Investigations done in outside hospital revealed anaemia with thrombocytopenia. Peripheral blood smear showed asexual forms of Plasmodium vivax and her rapid malaria antigen (QDx, Piramal Healthcare) test was positive for P. vivax. She was started on injection artesunate. Patient didn’t show significant improvement after 48 h of