Illness In India Research Articles

Prevalence and Risk Factors of Psychiatric Symptoms among Type 2 Diabetes Mellitus Patients in South India: A Cross-Sectional Study.

Background: Type 2 diabetes mellitus poses a momentous challenge when accompanied by psychiatric symptoms like depression, anxiety, and stress, adding to the complaint's threat. Research on these factors in patients with uncontrolled chronic illnesses in India, particularly in Tamil Nadu, is limited. Hence, this study aims to determine the prevalence and risk factors of these psychiatric symptoms among Type 2 diabetes patients.  Methods: A cross-sectional study was conducted in Alpha Hospital and Research Center in Madurai, South India, from April 2020 to March 2021, enrolling 614 participants (307 with Type 2 diabetes mellitus and 307 general population). Data were collected using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and Perceived Stress Scale. The IBM SPSS version 23 was used for statistical analysis.  Results: Two-thirds of youth women with type 2 diabetes have higher fasting blood sugar levels than men when compared to general population. 82.61% of patients with uncontrolled diabetes developed severe stress, surpassing those with well-controlled and pre-diabetes. Severe depression is most prevalent among patients with neuropathic foot ulcers (54.76%) and nephropathy (61.54%). Predominant mental health risk factors include being single, high school education, poor glycemic control, comorbid hypertension, and family history. Interestingly, lifestyle factors like alcohol use and smoking positively impact mental health outcomes.  Conclusion: This study shows the intricate connection between Type 2 diabetes and mental health problems in Madurai, emphasizing the necessity for a multidisciplinary strategy to enhance outcomes and reduce financial burden. Future research in nursing has to focus on implementing and assessing therapies aimed at reducing patients' stress, anxiety and depression.

Redefining disability certification for mental illness in India: Towards global standards and functional assessments

This viewpoint advocates for significant reforms in the disability certification guidelines for mental illnesses in India. Currently, two years duration of illness is required before certification, which delays essential support. The proposed model emphasizes assessing the functional impact of conditions, aligns with global standards, and suggests regular reassessments to improve accessibility and inclusivity in mental health services.

Amend the Mental Health Care Act 2017: A Survey of Indian Psychiatrists (Paper 1)

Aim: This paper highlights the difficulties and lacunae in the Mental Health Care Act 2017 that hinder its implementation and use for the care and treatment of persons with mental illness in India. Methods: An online nationwide survey, involving structured questions as well as open-ended questions, to elicit the level of implementation, experience in complying with the provisions of the Act, and level of satisfaction, of practicing psychiatrists was carried out. Responses were analyzed using appropriate statistics. Results: 600 respondents answered the online questionnaire. A majority of psychiatrists were senior practitioners with over 10 years of experience. 92.5% respondents were dissatisfied with the MHCA, wherein 73.3% wanted it amended, and 19.2% asked for repeal. Procedural issues were deterrent for 66.5% from taking medically necessary or helpful decisions for patients. Non-implementation of the Act was a major finding. Major dissatisfaction was expressed regarding judicial over reach in admission and discharge procedures, inclusion of general hospital psychiatry units in the definition of mental health establishment, non-applicability of provisions like advance directive and nominated representative in Indian setting, and that all treatment should be covered under insurance. Conclusion: The Act in its present form defies the spirit of its own objectives and is unimplementable. It needs major revisions.

Feasibility of remote delivery of a smoking cessation intervention for people with severe mental illness: a telephone consultation

Background The COVID-19 pandemic meant that face-to-face delivery of a smoking cessation intervention in India and Pakistan for people with severe mental illness within a feasibility trial was not possible. Rather than halt the feasibility trial, the decision was taken to adapt the intervention for remote delivery. This paper presents a telephone consultation conducted with key stakeholders to inform this adaptation. Objective To consult with key stakeholders on the feasibility, challenges and solutions for remote delivery of a smoking cessation intervention for people with severe mental illness in India and Pakistan. Design Rapid mixed-methods telephone consultation. Setting Two mental health facilities, one in Bengaluru, India, and the other in Rawalpindi, Pakistan. Participants Thirty-two members (16 India, 16 Pakistan) of Community Advisory Panels at the mental health facilities. Members were people with severe mental illness (2 India, 8 Pakistan), caregivers (3 India, 2 Pakistan) and professionals (11 India, 6 Pakistan). Data collection and analysis Questions explored general views on remote intervention delivery and specific feedback on nine intervention components (providing information, advising, asking questions, discussion, assessing motivation, using a flipbook, recording activities in a booklet, measuring exhaled carbon monoxide and administering medication). Telephone consultations were audio-recorded. Descriptive statistics were used for quantitative data, content analysis for qualitative data and then triangulated. Results All three participant groups identified challenges and solutions. Overall remote delivery was considered feasible with a preference for telephone sessions, supplemented with video, delivered for 30 minutes in the morning. Except for measuring carbon monoxide, all components were seen to be feasible, with more positive opinions evident in India. The key challenge related to achieving effective communication over the phone, especially for people with severe mental illness or low literacy. Access (connectivity and phone ownership) and monitoring medication use were other challenges. Popular solutions were to involve caregivers in all intervention components and to ensure these components and associated resources were appropriate for this patient group including those with low literacy. Based on this valuable feedback, the smoking cessation intervention was adapted for hybrid (remote and face-to-face) delivery instead of exclusive remote delivery with significant changes made to its delivery and content. Limitations This was a rapid consultation with a small sample of stakeholders. There were missing quantitative data in Pakistan. Conclusions Key stakeholders viewed remote delivery of the smoking cessation intervention among people with severe mental illness as feasible and particularly important when face-to-face delivery is not possible. The intervention was subsequently adapted for hybrid (remote and face-to-face) delivery. Future work Evaluating the feasibility and acceptability of hybrid delivery of this smoking cessation intervention was completed. A full trial commences in July 2024. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/130.

Leptospirosis in central India: A retrospective study to explore burden of tropical illness

Leptospirosis, an underdiagnosed zoonotic disease in India, was studied retrospectively in Madhya Pradesh, Central India. Between 2018 and 2019, 2617 samples from patients with hepatitis-related symptoms were collected. Of these, 518 tested negative for hepatitis and other tropical viral diseases under the VRDL project were analyzed for leptospira IgM using ELISA. 68 (13.12%) were positive for leptospirosis. Common symptoms included fever (97.45%) and jaundice (42.27%), with renal involvement in 30.88% of cases. Higher incidence was observed in the 31–60 age group, especially during monsoon and post-monsoon seasons. The study highlights the need for increased clinician awareness and inclusion of leptospirosis in screening panels to differentiate tropical illnesses in India.

Advancements and challenges in understanding gastrointestinal stromal tumors: A comprehensive review

The most common mesenchymal tumor affecting the gastrointestinal system is gastrointestinal stromal tumor (GIST). Although GISTs are a relatively new type of tumor, the under understanding of these tumors has increased quickly. Nevertheless, there is a dearth of research on this illness in India, and the majority of treatment plans are based on studies performed on populations outside of the nation. Since the 1990s, considerable progress has been made in our knowledge of the lineage of origin of the GIST domain. According to recent research, multipotent mesenchymal stem cells are the source of GISTs, which are thought to occur in 10-20 cases per million people annually. With the overexpression of the tyrosine kinase receptor KIT in intestinal Cajal cells, GISTs are the most prevalent malignant subepithelial lesions (SELs) in the digestive tract. GISTs can have a variety of morphologies, such as rhabdomyosarcoma, angiosarcoma, or undifferentiated pleomorphic sarcoma, which makes diagnosis difficult. However, new developments in molecular targeted therapy have transformed solid tumor oncology and provided exciting new avenues for treatment. To differentiate dedifferentiated GISTs from other gastrointestinal malignancies, this review paper will address current immunohistochemical markers and provide an outline of the morphologic and molecular features of these tumors. The findings also emphasize the importance of GIST genetic testing, progressive surgical approaches, adjuvant and neoadjuvant therapy for localized disorders, and metastatic condition-addressing methodologies. This article's major body explores the impact of imatinib therapy, the rarity of GISTs in pediatric patients, imaging methods for staging and monitoring, and difficulties with treating anorectal GISTs. This study highlights how crucial it is to pinpoint particular molecular subtypes to inform therapeutic choices for adjuvant and metastatic therapies.

Factors Contributing to Unmet Psychosocial Needs of the Homeless Persons with Mental Illness in India: A Narrative Review

Factors Contributing to Unmet Psychosocial Needs of the Homeless Persons with Mental Illness in India: A Narrative Review

Mental Health Insurance in India: An Examination of Policy Implementation Post-MHCA 2017

Purpose of review: Owing to the high cost of care and huge treatment gap associated with mental illnesses in India, this review investigated the implementation of mental health insurance coverage in India following the mandate of the Mental Health Care Act of 2017 (MHCA 2017). Collection and analysis of data: We systematically identified health insurance providers in India through the Insurance Regulatory and Development Authority of India (IRDAI) website. We meticulously searched and obtained policy documents from either the IRDAI website or the respective insurance company websites. Our classification process involved determining if a policy explicitly covered mental illness, which we discerned by examining definitions of mental illness, indemnification clauses or the presence of International Classification of Diseases-10 codes within the policy. Conclusion: We evaluated 235 policies provided by 30 insurance companies and found that 37.5% (88) of policies covered mental illnesses, 11.5% (28) covered persons with disabilities, whereas 51% (119) did not offer any coverage. The majority of the companies did not cover suicide and substance use disorders. There are disparities in the outpatient care offerings, including extended waiting periods for coverage of mental illness. This review highlights the importance of aligning insurance practices with MHCA 2017s provisions to promote mental health equity in India. It also advocates for comprehensive mental health coverage that includes outpatient care, substance use disorders and suicide as well as a need for standardized definitions and transparent policy communication.

Evaluation of serological tests in the diagnosis of scrub typhus

Scrub typhus is a leading cause of acute undifferentiated febrile illness in India. Overlapping clinical presentation and very low incidence of characteristic eschar makes serology the main stay of diagnosis. IgM ELISA is the most common test performed in tertiary care centres along with rapid diagnostic tests (RDT) and Weil Felix with varying sensitivity and specificityThe present study was conducted to compare the RDT’s and Weil Felix with IgM ELISA and analyse the demographic and clinical profile of scrub positive patientsSerum samples from clinically suspected scrub typhus patients admitted in a tertiary care hospital were tested by Weil Felix, RDT and IgM ELISA. Scrub typhus was confirmed in 38 of the 100 clinically suspected patients by IgM ELISA. Fever was the most common presenting symptom with significant proportion of patients being exposed to vegetation (p=0.0001).Sensitivity of Weil Felix and RDT was 42.1% and 84.2% respectively. Acute Kidney injury was the most common complication and mortality rate was 7.9%.Weil Felix is not a reliable test for scrub typhus diagnosis due to low sensitivity. Results of positive RDT’s can used for early initiation of specific treatment and IgM ELISA can be used as a confirmatory test in highly suspected cases.

Prevalence and gender difference in depression in primary health care in India: A systematic review and meta-analysis.

Depression contributes to the major burden of mental illness in India. Assessment of burden is essential to develop interventions to address the problem at the primary care level. We carried out a systematic review and meta-analysis of studies documenting the prevalence of depression in primary care in India. A wide literature search strategy was developed using keywords and Medical Subject Headings. The literature search was done in MEDLINE (via PubMed), IndMed, and major Indian psychiatric journal websites. The protocol was registered at PROSPERO. Bias assessment was carried out using a Cochrane risk of bias tool. A total of 186 studies were identified after an initial search, of which 17 were included in the final analysis using pre-specified inclusion and exclusion criteria. The aggregate point prevalence of depression at the primary care level of the 17 studies using the random-effect model was 23.0% (95% CI: 16.0-30.0%). Significant heterogeneity was reported among the studies attributed majorly to a variety of study tools for assessing depression. Sub-group analysis revealed the higher aggregated prevalence of depression among females as compared to males at the primary care level. The study provided updated evidence of higher and gender differential burden of depression at the primary care level in India.

Approach towards surveillance-based diagnosis of acute respiratory illness in India: Expert recommendations

BackgroundEmerging infectious diseases, often zoonotic, demand a collaborative “One-Health” surveillance approach due to human activities. The need for standardized diagnostic and surveillance algorithms is emphasized to address the difficulty in clinical differentiation and curb antimicrobial resistance. ObjectiveThe present recommendations are comprehensive diagnostic and surveillance algorithm for ARIs, developed by the Indian Council of Medical Research (ICMR), which aims to enhance early detection and treatment with improved surveillance. This algorithm shall be serving as a blueprint for respiratory infections landscape in the country and early detection of surge of respiratory infections in the country. ContentThe ICMR has risen up to the threat of emerging and re-emerging infections. Here, we seek to recommend a structured approach for diagnosing respiratory illnesses. The recommendations emphasize the significance of prioritizing respiratory pathogens based on factors such as the frequency of occurrence (seasonal or geographical), disease severity, ease of diagnosis and public health importance. The proposed surveillance-based diagnostic algorithm for ARI relies on a combination of gold-standard conventional methods, innovative serological and molecular techniques, as well as radiological approaches, which collectively contribute to the detection of various causative agents.The diagnostic part of the integrated algorithm can be dealt at the local microbiology laboratory of the healthcare facility with the few positive and negative specimens shipped to linked viral disease research laboratories (VRDLs) and other ICMR designated laboratories for genome characterisation, cluster identification and identification of novel agents.

Blindness as a presenting feature of leptospiral infection: A case report and review of literature

Leptospira is an emerging cause of acute febrile illness in India, which is acquired through contact of skin with contaminated water and soil. Generally, leptospirosis has mild, self-limiting course; rarely, multiple organ dysfunction can occur like aseptic meningitis (20%) and Weil’s disease (10%). Here, we report a case of bilateral optic neuritis in a girl child who presented with blindness following Leptospira infection. On ophthalmological examination, she could appreciate hand movements close to face and had afferent pupillary defect bilaterally. Fundoscopy showed normal fundus with no signs of disc edema. Magnetic resonance imaging (MRI) of brain and orbit showed bilateral hyperintensities in the optic nerve. Visual evoked potential showed prolonged latency in p100 wave in both eyes, suggestive of bilateral optic neuritis. She was diagnosed with Leptospira infection with aseptic meningitis and retrobulbar optic neuritis. She was treated conservatively. She responded well with improvement of visual acuity to 6/6 at the time of discharge.

Machine Learning Approach to Study Social Determinants of Chronic Illness in India: A Comparative Analysis.

Several studies on noncommunicable diseases (NCDs) have been carried out worldwide, the basis of most of which is the identification of risk factors-modifiable (or behavioral) and metabolic. Majority of the NCDs are due to sociodemographic factors, lifestyle, and behavior, which can be prevented to a great extent. Thus, it is a health challenge and a necessity to identify such factors of NCDs. The objective is to make a thorough systematic and comparative analysis of diverse machine learning (ML) classifiers and identify the best-performing model to study social determinants of NCDs. We used data from the Longitudinal Ageing Study in India, and predicted the prevalence of NCDs based on a set of sociodemographic, lifestyle, and behavioral risk factors by conducting a comparative analysis among 25 different algorithms. Evaluating the performance metrics, the random forest model was found to be the most-suited method with 87.9% accuracy and hence chosen as the final model for the analysis. The model's performance was optimized by a hyper-parameter tuning process using grid-search with a 5-fold cross-validation strategy and results suggested that it was able to make accurate predictions on new instances. The epidemic of chronic illness cannot be completely addressed without comprehending the social determinants. With advancements in medical and health-care industry, ML has been applied to analyze diseases based on clinical parameters. This work is an attempt by the authors to explore and encourage the use of ML in the field of social epidemiology.

Procalcitonin Levels for Prognosis of Scrub Typhus Patients: A Retrospective Observational Analysis from a Tertiary Care Centre in Northern India

Introduction: Scrub typhus is a major cause of acute febrile illness in India. It presents with various clinical features that vary from fever to multiorgan dysfunction. Similar symptoms and presentations cause difficulty in diagnosis. Therefore, it is important to have early and prompt diagnosis with better prognostic markers to decrease morbidity and mortality. Aim: To determine the prognosis of scrub typhus patients based on the Procalcitonin (PCT) levels. Materials and Methods: This retrospective observational study was conducted in the Microbiology Department of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India, from January 2022 to January 2023. A total of 120 patients admitted to the hospital, who tested positive for Scrub typhus IgM by ELISA during this period and had a negative blood culture, were included in this study. Data analysis was conducted from February 2023 to April 2023. PCT levels of all these patients at the time of admission were recorded. The demographic information, laboratory parameters, and treatment regimen of these patients were also compiled. Statistical analysis was performed, and p-value was used to determine statistical significance. Results: The majority of the patients belonged to the age group of 21-40 years. Among these, elevated PCT values (ranging from 0.05-89.4 ng/mL) were observed in 112 (93.33%) patients. Twelve (10%) patients died during the study period, and all of them had elevated PCT levels. Among these, six developed septic shock with Multiple Organ Dysfunction Syndrome (MODS). Increased leukocyte values, elevated liver enzymes such as Aspartate Aminotransferase (SGOT/AST) and Alanine Transferase (SGPT/ALT), abnormal coagulation profile, and abnormal renal profile with elevated urea and uric acid levels were found to be significantly associated with scrub typhus patients with elevated PCT values. Conclusion: There is a need to address the role of prognostic markers in the management of scrub typhus patients. This may lead to breakthroughs in the field of diagnostic research and help improve the prognosis of these patients.

Need for an Artificial Intelligence-based Diabetes Care Management System in India and the United States.

Diabetes mellitus is an important chronic disease that is prevalent around the world. Different countries and diverse cultures use varying approaches to dealing with this chronic condition. Also, with the advancement of computation and automated decision-making, many tools and technologies are now available to patients suffering from this disease. In this work, the investigators attempt to analyze approaches taken towards managing this illness in India and the United States. In this work, the investigators have used available literature and data to compare the use of artificial intelligence in diabetes management. The article provides key insights to comparison of diabetes management in terms of the nature of the healthcare system, availability, electronic health records, cultural factors, data privacy, affordability, and other important variables. Interestingly, variables such as quality of electronic health records, and cultural factors are key impediments in implementing an efficiency-driven management system for dealing with this chronic disease. The article adds to the body of knowledge associated with the management of this disease, establishing a critical need for using artificial intelligence in diabetes care management.

The historical sociology of medicine in India: Introduction to the special section.

This introduction to a special section brings together three papers first presented at a panel, 'Medical Professions in South Asia: Historical and Contemporary Analyses', at the 26th European Conference on South Asian Studies, held in Vienna, Austria and online, in July 2021. All three papers deal with aspects of the professionalisation of biomedical doctors in India since its independence in 1947. The authors bring together historical and sociological approaches to illuminate the growth of specialisms, patterns of practitioner-patient interactions and efforts to maintain occupational closure and maintain status in the face of growing challenges. The introduction concludes with a discussion of the relevance of these papers for the sociology of health and illness in India and beyond.

Role of faith healers in the treatment of severe mental illness in India

Background: The cultural diversity has influenced the beliefs of people regarding health and illness. An aim of the study was to assess the role of faith healers in the treatment of severe mental illness. Methods: It is a retrospective cross-sectional study with convenience sampling technique was used, on 123 caregivers of patients with severe mental illnesses using standardized tools like MINI, BPRS, and YMRS. Results: 41.5% participants firstly contacted faith healer while 86% visited faith healer anytime during the course of illness. 47.2% took treatment from faith healer for <6 months, 21.1% took 6-12 months and 17.9% more than 13 months. 22.8% circulated between faith healer to faith healer, 18.7% from psychiatrist to faith healer and 27.6% from medical professional to faith healer. Conclusions: There is an immense need to create awareness regarding mental illness and treatment options available.

Modeling the effect of non-pharmaceutical measures and vaccination on the spread of two variants of COVID-19 in India

An RNA virus, SARS-CoV-2 is capable of mutation, and vaccines developed to combat its earlier strains are comparatively less effective against its new emerging variants of concern. Therefore, it is proposed to formulate a two-strain COVID-19 deterministic model that incorporates non-pharmaceutical preventive strategies along with an imperfect and leaky vaccine. The control reproduction number (denoted by Rc) of the model is calculated using the next-generation matrix method. Rigorous model analysis elucidates that its disease-free equilibrium (DFE) is locally asymptotically stable when Rc<1. Using the central manifold theorem, the occurrence of subcritical bifurcation is proved when the relevant conditions required for its existence hold. However, the model exhibits transcritical bifurcation when the vaccinated population does not get infected. Additionally, the DFE point of this reduced case is globally asymptotically stable when Rc is sufficiently less than 1. Moreover, the model is analyzed to reveal the presence and global asymptotic stability (using the Lyapunov function approach) of endemic equilibrium points. The introduced model is calibrated and cross-validated with observed daily and cumulative data of Delta (1 April 2021 to 30 November 2021) and Omicron variant (1 December 2021 to 15 February 2022). Data fitting depicts that competitive exclusion exists among the variants as the Omicron variant tends to extinct other variants prevalent in that duration within a restricted timeframe. The model is examined, using the known and calibrated parameter values corresponding to the Omicron variant, to examine the impression of vaccination, quarantine, isolation, and lockdown on the prevalence of illness in India. The impact of fluctuations in vaccine and infection-induced immunities on daily and cumulative cases is studied. It is observed that vaccine-derived immunity exerts a greater influence on the current wave of the pandemic as compared to subsequent waves while natural infection immunity has a significant impact on future waves of the pandemic. Furthermore, there is a possibility of a future wave of the Omicron variant but with a relatively low peak. The minimum percentage of vaccinated people required to reach community-wide herd immunity has been estimated with respect to vaccine efficacy and various non-pharmaceutical control parameters.

Evaluation of Cardiovascular Response to Isometric Handgrip Exercise in Obese Individuals.

Background The variability in hemodynamic responses to isometric handgrip exercise in people with different body mass indices (BMIs) is noteworthy due to the frequent incidence of hypertension, obesity, and related cardiovascular illnesses in India. This investigation may be necessary to anticipate and prevent excessive heart strain during static activities. Therefore, this study aimed to evaluate the impact of isometric handgrip exercise on cardiorespiratory responses in an Indian population with varying BMI levels. The objective was to compare the cardiovascular responses of obese and non-obese individuals to an isometric handgrip exercise test (heart rate, systolic blood pressure, diastolic blood pressure, rate pressure product, and mean arterial pressure). Methodology This study was conducted from April 2021 to October 2022. Measurements were obtained using a pedestal-style weighing scale with a maximum capacity of 120 kg and an accuracy of 100 g at the Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna. Sphygmomanometer was used for measuring blood pressure, and a stopwatch was used to time the duration of each prolonged isometric contraction performed by the participants using a handgrip dynamometer. Baseline measurements of heart rate, blood pressure, cardiac output, and heart rate variability were done during the final three minutes of the rest phase and once more throughout the 10-minute recovery period that followed the isometric handgrip exercise. Results The average heart rate increased during the isometric handgrip exercise in the obese group (13.02 ± 1.88 beats per minute). Systolic blood pressure increased by 16.40 ± 2.65 mmHg and 23.66 ± 3.14 mmHg in the obese group and the normal weight group, respectively. The diastolic blood pressure increased similarly in the overweight and normal weight groups, measuring 18.64 ± 3.63 mmHg and 12.14 ± 1.95 mmHg, respectively. Furthermore, the mean blood pressure increased by 20.45 ± 3.13 mmHg and 13.67 ± 1.64 mmHg, respectively, both in the normal and overweight groups. Conclusions Obese individuals had greater resting heart rates, systolic blood pressure, and diastolic blood pressure than non-obese individuals. Following an isometric handgrip workout, non-obese individuals reported greater increases in heart rate, systolic blood pressure, and diastolic blood pressure than obese individuals.

Leptospirosis and Scrub Typhus Coinfection of a 50-year-old male: A Case study

The bacterial diseases, leptospirosis and scrub typhus are important causes of acute febrile illness in India and are responsible for high morbidity and mortality. The common epidemiology of the zoonotic diseases creates an opportunity of dual infection. In this study, we describe a medical case of a 50-year-old male who was reported to have high grade fever for 10 days along with chills and coughs and was admitted to the RG Kar Medical College and Hospital on November last year. He was reported to suffer from conjunctival congestion, episode of pr bleeding, bowel and bladder incontinence, abdominal distension and pedal edema. Enzyme linked immunosorbent assay (ELISA) detected IgM antibodies to both leptospirosis and scrub typhus in the serum of the patient indicating dual infection with both bacterial diseases. Timely diagnosis of the patient followed by treatment with the antibiotics and associated medication resulted in complete recovery from both the diseases. As both leptospirosis and scrub typhus present with similar clinical features, co-infection of these two diseases is not uncommon. Cases of dual infections must be therefore considered seriously and choice of therapy should include those drugs that cover for both the infections.