{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:05Z","timestamp":1760147285136,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["22wm0125010h0003"],"award-info":[{"award-number":["22wm0125010h0003"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Osaka University ASEAN campus project and the International Postdoctoral Fellowship 2021, Mahidol University through W.N. and H.A.I","award":["22wm0125010h0003"],"award-info":[{"award-number":["22wm0125010h0003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>The COVID-19 pandemic was the worst public-health crisis in recent history. The impact of the pandemic in tropical regions was further complicated by other endemic tropical diseases, which can cause concurrent infections along with COVID-19. Here, we describe the clinical course of a patient with concurrent COVID-19 and scrub typhus infection. The patient\u2019s de-identified clinical data were retrieved retrospectively. The patient had progressive breathlessness at the time of presentation and was hospitalized for COVID-19. Respiratory examination revealed dyspnea, tachypnea, and coarse crepitations bilaterally over the entire lung field. Oxygenation was impaired, and a PaO2\/FiO2 ratio of 229 suggested acute respiratory distress syndrome. Laboratory tests indicated leukocytosis, thrombocytopenia, ferritinemia, hypoalbuminemia, and transaminitis. Upon revaluation for persistent fever, physical examination revealed an eschar in the right antecubital fossa. Serology further confirmed scrub typhus, with IgM and IgG antibody positivity. A remarkable clinical recovery was achieved with doxycycline. The COVID-19 pandemic might have masked endemic tropical diseases. Clinicians working in endemic regions must always consider common tropical diseases that may present as a co-infection, as in our case. Travel and exposure history are critical guides for narrowing down a differential diagnosis. Early diagnosis and treatment can prevent complications.<\/jats:p>","DOI":"10.3390\/tropicalmed8020082","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T02:29:31Z","timestamp":1674700171000},"page":"82","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Concurrent Infection with SARS-CoV-2 and Orientia tsutsugamushi during the COVID-19 Pandemic in the Maldives"],"prefix":"10.3390","volume":"8","author":[{"given":"Rajib Kumar","family":"Dey","sequence":"first","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4812-6334","authenticated-orcid":false,"given":"Hisham Ahmed","family":"Imad","sequence":"additional","affiliation":[{"name":"Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok 10400, Thailand"},{"name":"Center for Infectious Disease Education and Research, Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pyae Linn","family":"Aung","sequence":"additional","affiliation":[{"name":"Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Faisham","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muaz","family":"Moosa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariyam","family":"Hasna","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aminath","family":"Afaa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1602-5435","authenticated-orcid":false,"given":"Thundon","family":"Ngamprasertchai","sequence":"additional","affiliation":[{"name":"Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok 10400, Thailand"},{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7165-2765","authenticated-orcid":false,"given":"Wasin","family":"Matsee","sequence":"additional","affiliation":[{"name":"Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok 10400, Thailand"},{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wang","family":"Nguitragool","sequence":"additional","affiliation":[{"name":"Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-0980","authenticated-orcid":false,"given":"Emi E.","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Education and Research, Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3439-8331","authenticated-orcid":false,"given":"Tatsuo","family":"Shioda","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Education and Research, Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.ijid.2020.03.004","article-title":"The SARS-CoV-2 outbreak: What we know","volume":"94","author":"Wu","year":"2020","journal-title":"Int. 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