Co-Infection of Scrub Typhus and Dengue in a Patient with Alcoholic Liver Disease: Diagnostic Dilemmas

Abstract

In the Asia-Pacific region, dengue fever and scrub typhus are predominant causes of unexplained acute febrile illness. Scrub typhus constitutes a significant health threat, affecting one billion individuals globally and resulting in illness in one million people annually. This disease, caused by Orientia tsutsugamushi, can lead to severe complications involving multiple organs. Conversely, dengue, a rapidly spreading viral infection primarily transmitted by Aedes aegypti and Aedes albopictus mosquitoes, presents an escalating health challenge in tropical and subtropical regions. Co-infections of scrub typhus and dengue exhibit high mortality rates, and both infectious diseases are prevalent in tropical areas, sharing clinical-epidemiological and laboratory features. This report describes a rare, previously unreported case of a middle-aged woman from the South Asian subcontinent with a prolonged history of alcohol consumption leading to alcoholic liver disease, who presented during the post-monsoon season with tropical illness, abdominal pain, and acute febrile illness. The patient was diagnosed with co-infections of scrub typhus and dengue fever through laboratory tests and was treated with doxycycline. This case also highlights the synergistic hepatocellular damage caused by the overlapping effects of dengue, scrub typhus, and alcoholic liver disease. Each condition individually contributes to elevated liver enzymes, but their coexistence can exaggerate hepatic dysfunction and complicate both diagnosis and management.