{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T21:07:50Z","timestamp":1782508070018,"version":"3.54.5"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T00:00:00Z","timestamp":1754179200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Departments of Medicine at the University of Toronto"},{"name":"University Health Network"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Given the overlap of epidemiological and clinical presentations of both rickettsioses and malaria infections, diagnostic testing where malaria is confirmed or excluded, without subsequent rickettsial testing, specifically in the case of Plasmodium vivax or P. ovale infection, may mask the possibility of relapse. A lack of clinical suspicion of co-infections, absence of knowledge on the geographic distribution of diseases, and lack of availability of point-of-care diagnostic testing for other tropical diseases can often lead to missed diagnosis or misdiagnosis of common tropical infections, including rickettsioses. We herein describe a case of confirmed intercurrent rickettsial and P. vivax infection, with the former potentially triggering a relapse of the latter in a febrile traveler returning to Canada from South America, and review the literature on tropical coinfections in returning travelers.<\/jats:p>","DOI":"10.3390\/pathogens14080768","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T07:45:11Z","timestamp":1754466311000},"page":"768","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute Rickettsiosis Triggering Plasmodium vivax Relapse in a Returned Traveler: A Case Report and Clinical Review of Travel-Related Coinfections"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1279-1738","authenticated-orcid":false,"given":"Ruchika","family":"Bagga","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada"},{"name":"Department of Pathobiology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Victoria Hospital, London Health Sciences Centre, London, ON N6A 5W9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Fuller","sequence":"additional","affiliation":[{"name":"DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalsoom","family":"Shahzad","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezra","family":"Bado","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Joshi","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dileesha","family":"Fernando","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3586-746X","authenticated-orcid":false,"given":"Amanda","family":"Hempel","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada"},{"name":"Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4, Canada"},{"name":"Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea K.","family":"Boggild","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada"},{"name":"Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4, Canada"},{"name":"Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada"},{"name":"Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.2310\/7060.2000.00075","article-title":"Health problems in a large cohort of Americans traveling to developing countries","volume":"7","author":"Hill","year":"2000","journal-title":"J. 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