Scrub typhus in false-positive dengue patients

Abstract

Scrub typhus is one of the tropical infections commonly seen in developing countries. The patients coming to health care centers with fever and thrombocytopenia should always be suspected for scrub typhus, along with malaria, dengue, and leptospiral infection. False-negative test or delay in the diagnosis can increase morbidity and mortality. We are reporting a series of five cases where the patients presented with fever to a local health care facility; on investigation, the patients were found to have thrombocytopenia. The dengue kit/card (qualitative test) test was found to be positive and the patients were treated accordingly; later, after 5 days, these patients noticed breathlessness and decreased urine output for which they were referred to a higher center and on further investigation, they were found to be negative for dengue serology (quantitative test) and positive for Weil-Felix test (WFT). All the five patients were successfully managed with invasive ventilator support and renal replacement therapy. This case report mainly emphasizes the suspicion of scrub typhus in patients with fever and thrombocytopenia, even if they are positive for other tropical infections, and timely doxycycline treatment, along with systemic supportive measure, are necessary for a successful outcome.