Volume 77, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


We retrospectively analyzed patients with leptospirosis (n = 35), scrub typhus (n = 45), and coinfection (leptospirosis and scrub typhus [n = 7]) to facilitate the detection of coinfection. Our data showed that factors favoring these disease entities included animal contact, an aspartate aminotransferase/alanine aminotransferase ratio > 2 (for leptospirosis); outdoor exposure, lymphadenopathy, splenomegaly, eschar, and elevated alkaline phosphatase levels (for scrub typhus and coinfection); calf tenderness, conjunctival suffusion, jaundice, oliguria, elevated total bilirubin levels and serum creatinine levels (for leptospirosis and coinfection); and maculopapular rash (for scrub typhus). Patients at risk for leptospirosis are often at increased risk for scrub typhus and . Lack of knowledge of coinfection may jeopardize the health of affected patients. Our study serves as a reminder of potential coinfection and provides clues for its detection.


Article metrics loading...

Loading full text...

Full text loading...



  1. Levett PN, 2001. Leptospirosis. Clin Microbiol Rev 14 : 296–326.
  2. Farr RW, 1995. Leptospirosis. Clin Infect Dis 21 : 1–6.
  3. Yang CW, Pan MJ, Wu MS, Chen YM, Tsen YT, Lin CL, Wu CH, Huang CC, 1997. Leptospirosis. An ignored cause of acute renal failure in Taiwan. Am J Kidney Dis 30 : 840–845.
  4. Chung KJ, Hsiao CT, Liu JW, Lee CH, 2002. Case reports of leptospirosis in southern Taiwan. J Formos Med Assoc 101 : 514–518.
  5. Yang HY, Hsu PY, Pan MJ, Wu MS, Lee CH, Yu CC, Hung CC, Yang CW, 2005. Clinical distinction and evaluation of leptospirosis in Taiwan—A case-control study. J Nephrol 18 : 45–53.
  6. Daher E, Zanetta DM, Cavalcante MB, Abdulkader RC, 1999. Risk factors for death and changing patterns in leptospirosis acute renal failure. Am J Trop Med Hyg 61 : 630–634.
  7. Lee HC, Ko WC, Lee HL, Chen HY, 2002. Clinical manifestations and complications of rickettsiosis in southern Taiwan. J Formos Med Assoc 101 : 385–392.
  8. Watt G, Parola P, 2003. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis 16 : 429–436.
  9. Watt G, Jongsakul K, Suttinont C, 2003. Possible scrub typhus coinfections in Thai agricultural workers hospitalized with leptospirosis. Am J Trop Med Hyg 68 : 89–91.
  10. Suputtamongkol Y, Niwattayakul K, Suttinont C, Losuwanaluk K, Limpaiboon R, Chierakul W, Wuthiekanun V, Triengrim S, Chenchittikul M, White NJ, 2004. An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis. Clin Infect Dis 39 : 1417–1424.
  11. Brown GW, Robinson DM, Huxsoll DL, Ng TS, Lim KJ, 1977. Scrub typhus: a common cause of illness in indigenous populations. Trans R Soc Trop Med Hyg 70 : 444–448.
  12. Watt G, Padre LP, Tuazon, Calubaquib C, Santiago E, Ranoa CP, Laughlin LW, 1988. Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. Lancet 1 : 433–435.
  13. Levett PN, 2003. Leptospira and leptonoma. Murray PR, Baron EJ, Pfaller MA, Yolken RH, eds. Manual of Clinical Microbiology. 8th edition. Washington, DC: American Society for Microbiology Press, 929–936.
  14. Chen HL, Shieh GJ, Chen HY, Horng CB, 1995. Isolation of Rickettsia tsustsugamushi from blood samples of patients in Taiwan. J Formos Med Assoc 94 : S112–S119.
  15. Berman SJ, Kundin WD, 1973. Scrub typhus in southern Vietnam. A study of 87 cases. Ann Intern Med 79 : 26–30.
  16. Hu ML, Liu JW, Wu KL, Lu SN, Chiou SS, Kuo CH, Chuah SK, Wang JH, Hu TH, Chiu KW, Lee CM, Changchien CS, 2005. Abnormal liver function in scrub typhus. Am J Trop Med Hyg 73 : 667–668.

Data & Media loading...

  • Received : 11 Apr 2007
  • Accepted : 13 Jun 2007

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error