title: Co-infection of scrub typhus and leptospirosis in patients with pyrexia of unknown origin in Longding district of Arunachal Pradesh in 2013.
abstract: BACKGROUND
  Scrub typhus and leptospirosis are bacterial zoonotic disease causing high morbidity and mortality. The seasonal outbreak of pyrexia is common in Arunachal Pradesh (AP); many times the disease remains undiagnosed.
  
  
  OBJECTIVE
  An outbreak of pyrexia of unknown origin (PUO) occurred in Longding district of Arunachal Pradesh in 2013, with 108 deaths, which was investigated to elucidate the cause of illness.
  
  
  METHODS
  Blood samples from the affected region with acute pyrexia were collected, and screened for the malaria parasite, scrub typhus IgM and leptospira IgM.
  
  
  RESULTS
  Scrub typhus IgM was reactive in 97% (30/31), and 25% (8/31) cases were co-infected with leptospira. Incidentally, scrub typhus reactive (67%) and leptospira co-infection (62.7%) were higher in females. Record of previous 3 years (2011-2013) from Longding, Community Health Centre showed an increase in indoor pyrexia cases by 2-fold or more during October and November.
  
  
  CONCLUSIONS
  The present study is the first report of co-infection of scrub typhus with leptospirosis from Northeast India. Medical officers in this region should take scrub typhus and leptospirosis in their differential diagnosis of patients with PUO for early diagnosis and effective treatment.
authors.forename: Biswajyoti
authors.initials: B
authors.lastname: Borkakoty
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Jakharia
authors.affiliation: Department of Microbiology, Regional Medical Research Center, NE-Region, Dibrugarh, Assam, India.
authors.forename: Dipankar
authors.initials: D
authors.lastname: Biswas
authors.forename: Jagadish
authors.initials: J
authors.lastname: Mahanta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D005335:Fever of Unknown Origin / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007922:Leptospirosis / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012612:Scrub Typhus / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D007075:Immunoglobulin M