Coinfection of malaria and scrub typhus in a toddler: First report from South India

Tropical infections are common in South Asia, including India. However, coinfections among the different diseases are rare in children. We report a case of malaria-scrub typhus coinfection in a toddler from South India. A 3-year-old boy presented with fever. He was pale, dull-looking and had hepatosplenomegaly.. There was mild leukocytosis with positive C reactive protein. Rapid malarial antigen was positive, and started on antimalarial therapy. Fever was persisting after 48 h and doxycycline was started. Scrub typhus immunoglobulin M was positive. He responded dramatically to doxycycline, and in 24 hours, he became afebrile. The prevalence of this coinfection was studied by Wilairatana et al. in 2021 and showed a low prevalence of 0%–1%. Our case is unique and rare as this has not been reported in a toddler. Children with acute undifferentiated fever which is not responding to therapy within 48 hours must be investigated for concurrent infection.