• 1

    Tangkanakul W, Tharmaphornpil P, Plikaytis BD, Bragg S, Poonsuksombat D, Choomkasien P, Kingnate D, Ashford DA, 2000. Risk factors associated with leptospirosis in northeastern Thailand. Am J Trop Med Hyg 63 :204–208.

    • Search Google Scholar
    • Export Citation
  • 2

    Tanskul P, Linthicum KJ, 1999. Redescription of Leptotrombidium (Leptotrombidium) imphalum (Acari: Trombiculidae), with observations on bionomics and medical importance in northern Thailand. J Med Entomol 36 :88–91.

    • Search Google Scholar
    • Export Citation
  • 3

    Watt G, 1997. Leptospirosis. Curr Opin Infect Dis 10 :149–152.

  • 4

    Levett PN, 2001. Leptospirosis. Clin Microbiol Rev 14 :296–326.

  • 5

    van Crevel R, Speelman P, Gravekamp C, Terpstra WJ, 1994. Leptospirosis in travelers. Clin Infect Dis 19 :132–134.

  • 6

    Smits HL, Ananyina YV, Chereshsky A, Dancel L, Lai-A-Fat RF, Chee HD, Levett PN, Masuzawa T, Yanagihara Y, Muthusethupathi MA, Sanders EJ, Sasaki DM, Domen H, Yersin C, Aye T, Bragg SL, Gussenhoven GC, Goris MG, Terpstra WJ, Hartskeerl RA, 1999. International mulitcenter evaluation of the clinical utility of a dipstick assay for detection of Leptspira-specific immunoglobulin M antibodies in human serum specimens. J Clin Microbiol 37: 2904–2909.

    • Search Google Scholar
    • Export Citation
  • 7

    Watt G, Strickman D, Kantipong P, Jongsakul K, Paxton H, 1998. Performance of a dot blot immunoassay for the rapid diagnosis of scrub typhus in a longitudinal case series. J Infect Dis 77 :800–802.

    • Search Google Scholar
    • Export Citation
  • 8

    Trishnananda M, Vasuvat C, Harinasuta C, 1964. Investigation of scrub typhus in Thailand. J Trop Med Hyg 67 :215–219.

  • 9

    Tsay RW, Chang FY, 1998. Serious complications in scrub typhus. J Microbiol Immunol Infection 31 :240–244.

  • 10

    Watt G, Padre LP, Tuazon ML, Calubaquib C, Santiago E, Ranoa CP, Laughlin LW, 1988. Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. Lancet 1 :433–435.

    • Search Google Scholar
    • Export Citation
  • 11

    Silpapojakul K, 1997. Scrub typhus in the Western Pacific region. Ann Acad Med Singapore 26 :794–800.

  • 12

    McClain JB, Ballou WR, Harrison SM, Steinweg DL, 1988. Doxycycline therapy for leptospirosis. Ann Intern Med 100 :696–698.

  • 13

    Stone SC, McNutt E, 2000. Update: Outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000-Borneo, Malaysia, 2000. Ann Emerg Med 38 :83–84.

    • Search Google Scholar
    • Export Citation





View More View Less
  • 1 Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Internal Medicine, Maharaj Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Restricted access

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.

Author Notes

Reprint requests: George Watt, HIV Interaction Section, Department of Retrovirology, AFRIMS, APO AP 96546, E-mail: wattgh@thai.amedd.army.mil