Concurrent Coinfections in Tropics: A Hospital-Based Observational Study from Himachal Pradesh, India

Abstract

India is the epicenter of tropical fever diseases. Large numbers of cases are diagnosed with scrub typhus, leptospirosis, malaria, dengue, chikungunya, and enteric fever. Coinfections as an etiology of acute undifferentiated fever (AUF) have been recently recognized. The objective of this study was to assess the prevalence of coinfections in patients admitted with AUF in a tertiary-care hospital in the rural setting of Himachal Pradesh, India. Patients with coinfections as an etiology of AUF were the subjects of the study. The clinical records of patients diagnosed with confections between July 2018 and October 2018 were analyzed retrospectively in this hospital-based cross-sectional study. Standard protocol and guidelines were followed for the case definitions. Among total patients of 1005 with AUF, 14 (1.39%) patients were found to have coinfections. The most common coinfection was scrub typhus with leptospirosis and was diagnosed in seven (50%) patients. Other coinfections were scrub typhus with dengue in four (29%) and one patient each with scrub typhus and tubercular meningitis, scrub and influenza A (H1N1/2009) infection, and scrub and malaria (P. falciparum). Scrub typhus was the most common etiological diagnosis for the AUF and was observed in 159 (15.8%) patients. All the patients with coinfections had scrub typhus as the common infection. The prevalence of coinfections among scrub typhus patients constituted 8%. In tropical regions, coinfections are not very rare. High clinical suspicion for coinfections is required. Syndromic approach in the management is justified.