Leptospirosis with Indian Tick-borne Typhus Coinfection: A Rare Presentation of Tropical Febrile Illness.

Introduction: Leptospirosis and tick-borne typhus are zoonotic diseases, rarely reported as coinfection. More specific molecular tests are not easily accessible for diagnosis of these diseases, thus resulting in delayed diagnosis and eventually considerable morbidity and mortality.

Case description: We report a case of leptospirosis with tick-borne typhus coinfection in an abattoir worker who presented with a short history of fever, myalgia, jaundice, nonoliguric renal failure, diffuse petechial rash, and altered sensorium. His lab investigations showed leukocytosis, raised C-reactive protein (CRP), elevated transaminases and creatinine, mild pleocytosis, and mildly raised proteins in cerebrospinal fluid (CSF). Serology for Leptospira IgM was positive by enzyme-linked immunosorbent assay (ELISA). A paired Weil-Felix test (WFT) showed a fourfold increase in OX19 and OX2 titers. The patient responded well to IV antibiotic therapy and was discharged. This is the first time that leptospirosis and Indian tick-borne typhus coinfection has been reported from western India.

Conclusion: Leptospirosis and Indian tick-borne typhus coinfection is a rare but important cause of tropical fever. Arduous efforts to establish a definitive diagnosis help not only in surveillance for epidemiological data of the disease entities but also in avoiding severe complications resulting from considerable delay in appropriate therapy.