Concomitant malaria and murine typhus infection with pulmona
Published in BMJ, the authors report a case of Plasmodium vivax and murine typhus coinfection in a 30-year-old woman who presented with intermittent, high-grade fever. Her peripheral blood smear showed ring-form trophozoites of P. vivax, with an initial murine typhus serological test being negative.

Although the P. vivax 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.

Lessons learnt:-
- 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 1–2 weeks is therefore recommended.

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