A Case of Mixed Infections in a Patient Presenting with Acute Febrile Illness in the Tropics

Concurrent infections with more than one etiological agent can result in an illness with overlapping symptoms, resulting in a situation where the diagnosis and management of such a patient could be challenging. We report a case of vivax malaria in a patient who was also serologically positive for leptospirosis and dengue. 1. Introduction Mixed infections are not uncommon in the tropics. Dengue usually presents with symptoms of flu-like illness such as high-grade fever, generalized body ache, arthralgia, myalgia, nausea, and vomiting as well as maculopapular rashes. The symptoms of dengue may mimic other diseases such as leptospirosis and malaria which are also prevalent in areas where dengue is endemic [1]. The similarity in symptomatology between these 3 infectious diseases may sometimes complicate the diagnosis of a patient presenting with acute fever. Laboratory investigations are often necessary to arrive at a definite diagnosis. However, interpreting laboratory results in the setting of mixed infection may prove to be challenging. For instance, a patient who presents with acute febrile illness in the tropics and is found to be dengue IgM serology positive should not be automatically assumed to have dengue infection. The astute clinician should look for other causes of fever if atypical presentations in the patient arouse suspicion of the presence of other possible etiologies. We report a case of a patient who presented with fever and thrombocytopenia with multiple positive laboratory results pointing to several possible etiologies. We would like to highlight several learning issues from this case. 2. Case Report A 47-year-old man from Pakistan initially presented with complaints of high grade fever with rigors of 6-day duration which was associated with throbbing headache, periorbital pain, generalized body aches, myalgia, fatigue, and anorexia. He denied any bleeding tendencies or skin rash. The patient worked as a waiter in a local restaurant. There was no significant past medical history or travel history. Although he lived in an urban area known to be endemic for dengue, no recent fogging has been carried out in that area. On examination, the patient was conscious and oriented but was mildly dehydrated. No skin rashes or hemorrhagic manifestations were observed. His blood pressure was 100/70？mmHg and the pulse rate was 100/min which was regular and of good volume. His temperature was 38.3°C. Examinations of the respiratory, cardiovascular, and gastrointestinal systems were unremarkable. An initial diagnosis of dengue in the febrile phase of the