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Her peripheral blood smear showed ring-form trophozoites of <jats:italic>P. vivax<\/jats:italic>, with an initial murine typhus serological test being negative. Although <jats:italic>the P. vivax<\/jats:italic> infection was successfully treated, she still had intermittent, high-grade fever, developed dyspnoea and bilateral interstitial pneumonitis shown in the chest X-ray. Thus, coinfection was suspected, and empirical antibiotics were given. The second serological test confirmed the concomitant murine typhus infection, and antibiotics treatment were successful with the complete recovery. This case emphasises that an initial negative murine typhus serological test does not necessarily rule out the presence of the disease. A follow-up murine typhus serological or molecular test within 1\u20132 weeks is therefore recommended.<\/jats:p>","DOI":"10.1136\/bcr-2018-226139","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T17:19:47Z","timestamp":1545153587000},"page":"e226139","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Concomitant <i>Plasmodium vivax<\/i> malaria and murine typhus infection with pulmonary involvement"],"prefix":"10.1136","volume":"11","author":[{"given":"Chayasin","family":"Mansanguan","sequence":"first","affiliation":[{"name":"Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weerapong","family":"Phumratanaprapin","sequence":"additional","affiliation":[{"name":"Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,9]]},"reference":[{"key":"2025082710250070000_11.1.e226139.1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-11-142"},{"key":"2025082710250070000_11.1.e226139.2","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/S2221-1691(15)30379-8","article-title":"Medley of infections-a diagnostic challenge","volume":"5","author":"Bhat","year":"2015","journal-title":"Asian Pac J Trop Biomed"},{"key":"2025082710250070000_11.1.e226139.3","doi-asserted-by":"publisher","DOI":"10.3201\/eid2008.131421"},{"key":"2025082710250070000_11.1.e226139.4","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.idcr.2017.05.006","article-title":"Severe interstitial pneumonia due to murine typhus in a patient returning from Bali","volume":"9","author":"Malheiro","year":"2017","journal-title":"IDCases"},{"key":"2025082710250070000_11.1.e226139.5","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-200938"},{"key":"2025082710250070000_11.1.e226139.6","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1128\/cdli.2.3.356-360.1995","article-title":"Comparative evaluation of a commercial enzyme immunoassay for the detection of human antibody to Rickettsia typhi","volume":"2","author":"Kelly","year":"1995","journal-title":"Clin Diagn Lab Immunol"},{"key":"2025082710250070000_11.1.e226139.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1991.03470100057033"},{"key":"2025082710250070000_11.1.e226139.8","doi-asserted-by":"publisher","DOI":"10.1086\/527443"},{"key":"2025082710250070000_11.1.e226139.9","first-page":"1","article-title":"Possible acute coinfections in Thai malaria patients","volume":"37","author":"Singhsilarak","year":"2006","journal-title":"Southeast Asian J Trop Med Public Health"},{"key":"2025082710250070000_11.1.e226139.10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000888"},{"key":"2025082710250070000_11.1.e226139.11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13071-017-2075-y","article-title":"Serological evidence of exposure to Rickettsia felis and Rickettsia typhi in Australian veterinarians","volume":"10","author":"Teoh","year":"2017","journal-title":"Parasit Vectors"},{"key":"2025082710250070000_11.1.e226139.12","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-202998"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bcr-2018-226139","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-226139","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:25:08Z","timestamp":1756315508000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-226139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12,9]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/bcr-2018-226139"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-226139","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}