SARS-CoV-2 and Orientia tsutsugamushi co-infection in a young teen, Nepal: Significant burden in limited-resource countries in Asia?

Anup Bastola (Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal)
Ranjit Sah (Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal National Public Health Laboratory, Kathmandu, Nepal)
Sagar K. Rajbhandari (Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal)
Runa Jha (National Public Health Laboratory, Kathmandu, Nepal)
Zareena Fathah (King’s College London, London, United Kingdom)
Bimal S. Chalise (Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal)
Bikesh Shrestha (Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal)
Rajesh K. Shah (Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal)
Pujan Balla (Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal)
Richa Nepal (Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal)
Bipin Adhikari (Nepal Community Health and Development Centre, Kathmandu, Nepal Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom)
Ali A. Rabaan (Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia)
Kuldeep Dhama (Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India)
Alfonso J. Rodriguez-Morales (Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia School of Medicine, Universidad Privada Franz Tamayo, Cochabamba, Bolivia)

Narra J
Vol. 1 No. 2 (2021): August 2021

Scrub typhus is caused by Orientia tsutsugamushi, transmitted through bites of infected chiggers (larval mites). During the coronavirus disease 2019 (COVID-19) pandemic, reports of co-infections with endemic pathogens are increasing around the world. Disease with similar clinical presentation may mask other disease diagnosis and increase the morbidity and mortality of the patients. We report co-infection between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and O. tsutsugamushi in a patient in Nepal presenting with fever, headache, retro-orbital pain, generalized body ache, and knee joints pain with a history of dry cough and dyspnea at night. Since scrub typhus is prevalent and considerate as one of the public health consents in Asian countries and the possible overlapping clinical manifestation with other infections including COVID-19, a further investigation required to determine the burden of SARS-CoV-2 and O. tsutsugamushi co-infection in scrub typhus-endemic countries in Asia.