Concurrent Infection with SARS-CoV-2 and Orientia tsutsugamushi during the COVID-19 Pandemic in the Maldives

Abstract

The COVID-19 pandemic was the worst public-health crisis in recent history. The impact of the pandemic in tropical regions was further complicated by other endemic tropical diseases, which can cause concurrent infections along with COVID-19. Here, we describe the clinical course of a patient with concurrent COVID-19 and scrub typhus infection. The patient’s de-identified clinical data were retrieved retrospectively. The patient had progressive breathlessness at the time of presentation and was hospitalized for COVID-19. Respiratory examination revealed dyspnea, tachypnea, and coarse crepitations bilaterally over the entire lung field. Oxygenation was impaired, and a PaO2/FiO2 ratio of 229 suggested acute respiratory distress syndrome. Laboratory tests indicated leukocytosis, thrombocytopenia, ferritinemia, hypoalbuminemia, and transaminitis. Upon revaluation for persistent fever, physical examination revealed an eschar in the right antecubital fossa. Serology further confirmed scrub typhus, with IgM and IgG antibody positivity. A remarkable clinical recovery was achieved with doxycycline. The COVID-19 pandemic might have masked endemic tropical diseases. Clinicians working in endemic regions must always consider common tropical diseases that may present as a co-infection, as in our case. Travel and exposure history are critical guides for narrowing down a differential diagnosis. Early diagnosis and treatment can prevent complications.

Scrub Typhus: Epidemiology, Clinical Presentations, and Diagnostic Approaches

“…Scrub typhus presents diagnostic challenges, as it closely resembles other febrile illnesses such as dengue, typhoid fever, leptospirosis, murine typhus and corona virus [8,90].The presence of an eschar in patients can aid in the clinical diagnosis of scrub typhus with higher specificity, but it often goes unnoticed as it is non-itching, painless, and typically present in areas like the perineum, groin, and axilla [91]. Available studies reported the prevalence of eschar and rash ranging from 7% to 28.8% and 1.69% to 28%, respectively.…”