Triple coinfections of Brucella abortus, scrub typhus, and S. typhi in the subtropical region of Nepal: A rare case report

Background Brucella is a zoonotic bacterial infection that requires antibiotic treatment. Four of the six traditional diseases cause human zoonoses: B. melitensis , B. abortus , B. suis , and B. canis . B. melitensis causes the majority of cases worldwide, but B. abortus is often misdiagnosed. The lack of clear symptoms often leads to the underdiagnosis of scrub typhus, another endemic disease in Nepal. In Nepal, typhoid, dengue fever, and scrub typhus spread during the monsoon and post monsoon seasons, often coinfecting each other. Case presentation: A 35-year-old female patient with fever, fatigue, and myalgia presented to Damak Hospital in Jhapa, Nepal, with no history of close contact with animals. We admitted her due to her fever, fatigue, and myalgia, and initial reports revealed a decrease in her hemoglobin and platelets. Routine urinalysis and stools were normal, but the patient tested positive for the S. typhi O antigen. Enzyme-linked immunosorbent assay (ELISA) tests revealed positive results for scrub typhus and Brucella abortus antigens. Conclusion: This study identified triple coinfection via enzyme-linked immunosorbent assay (ELISA) and Widal testing in rural areas, with the aim of early detection in endemic regions such as Nepal and South Asia.