Co-infection of dengue, leptospirosis and murine typhus: A rare case in endemic region

Tropical diseases often present as fever with non-specific symptoms known as acute undifferentiated febrile illness. This poses a substantial diagnostic problem made more difficult in the setting of co-infection, although these are seldom reported. Here, a case report is presented of a 31-year-old Thai man with fever for seven days, whose clinical picture and laboratory results were not compatible with a classic syndrome of a single tropical disease. Subsequent comprehensive investigations revealed co-infection of dengue infection (without warning signs), leptospirosis and murine typhus. Empirical antibiotic treatment with doxycycline was prescribed and the patient was discharged on Day 3 after admission.