Bacterial coinfections in dengue virus disease: what we know and what is still obscure about an emerging concern

Abstract

Despite the real burden and consequences of this emerging concern is still not computable accurately due to the lack of a significant number of studies on large cohorts, clinicians need a greater awareness about it to early recognize warning signs, to properly use available diagnostic tools and to readily start antibiotic treatment able to prevent worsening in mortality and morbidity.

Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting

“…The group also noted an important lack of trials focusing on some specific patient populations important to Asia-Pacific countries, such as tropical diseases [16][17][18][19][20][21][22][23][24][25][26]. Because of the lack of strong trial data currently limiting the clinical utility in these patients, there is need for adaptation of the proposed algorithms.…”

“…A drop in PCT from the peak by ≥80% and/or fall below the cut-off was taken as a strong indicator for resolution of illness, and earlier discontinuation of antibiotics is recommended when the patient is clinically stable. Discussing the application of the algorithms in the context of the Asia-Pacific patient population, it was emphasized that for patients with clinical suspicion of tropical diseases such as malaria, Dengue fever or hemorrhagic fever, and other diseases with high prevalence in the region, such as tuberculosis or typhus, there is a lack of systematic PCT studies in general and of antibiotic stewardship studies in particular [16][17][18][19][20][21][22]. There are some studies suggesting that PCT may help to risk-stratify these patients and provide prognostic information, but more research is needed to understand the role of PCT in these clinical conditions before applying PCT-guided antibiotic stewardship to them.…”

“…Lack of evidence for some patient populations Tropical disease Few studies have looked at tropical diseases (e.g. malaria, dengue fever, rickettsia, typhoid); current data have been inconclusive on whether PCT improves stewardship, PCT may provide prognostic information [16][17][18][19][20][21][22][23][24][25][26] Tuberculosis Few studies on tuberculosis, PCT remains low in patients with tuberculosis limited to the lung but increases in severe cases with systemic infection [27,28] Hemorrhagic fever syndrome Few studies have looked at hemorrhagic fever syndromes, PCT has been reported to be increased in severe cases despite lack of bacterial infection, PCT seems to provide prognostic information [16,17] Lack of research in Asia-Pacific countries There has been little research done in Asia-Pacific countries, particularly regarding interventional research; thus unclear how PCT impacts antibiotic use in clinical routine in the very different countries and health care environments in this region [29,30] Resources Cost to the hospital Added costs for PCT testing are often only compared to the very low antibiotic costs in some countries, without considering other potential cost savings like from shorter LOS, reduced adverse effects like C. diff. etc.…”

Enterobacter cloacae co-infection in a child with primary dengue fever

“…Discussion A study in Singapore showed 0.3% prevalence of bacteraemia among adult patients with dengue and Staphylococcus aureus was the commonest pathogen 4 . Being critically ill at presentation, comorbidities, advanced age and more severe dengue manifestations are risk factors for bacteraemia in adults 4,5 . A study in Sri Lanka showed that 25% of adult dengue patients with fever lasting more than 5 days have bacteraemia 6 .…”

“…Bacterial co-infection increases the morbidity and mortality of dengue. Bacterial co-infections are associated with 14.3-44.4% mortality 5 . Salmonella typhi co-infection was reported in a child with dengue fever in India 7 .…”