Clinical features and outcomes of dengue and scrub typhus in hospitalized adults in the Maldives

Background: Dengue and scrub typhus are common causes of acute undifferentiated febrile illness in the Maldives. Methods: This retrospective study compared the clinical characteristics of 184 hospitalized adults diagnosed with dengue (n = 94) or scrub typhus (n = 90) at a national referral hospital in the Maldives. Clinical data were collected from 2013 to 2021 for scrub typhus and from 2018 to 2021 for dengue, identified using ICD-10 codes from both physical and electronic records. National dengue and scrub typhus data from 2015 to 2024 were obtained from the Health Protection Agency of the Maldives. Results: Scrub typhus patients were generally older, with a median age of 42.5 years compared to 27 years in dengue, were more often locals, and tended to present later in the course of illness, on day 10 compared to day 4. Furthermore, scrub typhus patients experienced more complications, 23.9 % compared to 3.2 % in dengue, which resulted in longer hospital stays. An eschar was observed in 63.1 % of scrub typhus cases, serving as a useful diagnostic clue. In contrast, dengue patients more often presented with chills, myalgia, arthralgia, bleeding, and thrombocytopenia. There were no fatalities in this cohort. Conclusions: In acute undifferentiated febrile illness in the Maldives, certain clinical indicators, including eschar for scrub typhus and bleeding with severe thrombocytopenia can aid in bedside diagnosis. Identifying these features can help clinicians in resource-limited settings provide timely and appropriate care.