Introduction
Dengue is a tropical disease which is primarily caused by Aedes aegypti and Aedes albopictus . It is particularly prevalent in tropical and subtropical regions, and has been expanding into new geographic areas throughout time 1. Scrub typhus, which is caused by the bacteria Orientia tsutsugamushi , is another disease to be concerned aboutdue to its endemicity in Nepal. The lack of distinct clinical symptoms and diagnostic resources, scrub typhus is frequently under-diagnosed2. Another endemic febrile sickness in Nepal is typhoid fever; causative agentSalmonella typhi, and causes multi-systemic illness when contaminated food and water is consumed3.
Monsoon and post-monsoon is a high risk season for spreading of typhoid, dengue, and scrub-typhus4. Even though, the co-infections among the organisms are rare due to multiple etiological agents and/or vector involved, the probability cannot be neglected. Here, we present a case of 58 years old female from Dang, a district with sub-tropical climate, having co-infection of dengue, typhoid fever, and scrub typhus during dengue outbreak in Nepal.