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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.
Received March 6, 2002. Accepted for publication September 25, 2002.
Acknowledgments: The authors thank the staff of the Department of Internal Medicine, Maharaj Hospital, for referring patients and providing essential help in conducting this study. Rudy Hartskeerl, Henk L. Smits, and the staff at the Royal Tropical Institute, the Netherlands, kindly provided microscopic agglutination test facilities. Disclaimer: The opinions or assertions in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army.
Reprint requests: George Watt, HIV Interaction Section, Department of Retrovirology, AFRIMS, APO AP 96546, E-mail: wattgh{at}thai.amedd.army.mil
Authors’ addresses: George Watt and Krisada Jongsakul, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, APO AP 96546, USA. Chuanpit Suttinont, Department of Internal Medicine, Maharaj Nakhon Ratchasima Hospital, 49 Chang-Phuek Road, Amphur Muang, Nakhon Ratchasima 30000, Thailand.
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