Clinical and Laboratory Characteristics of Dengue-Orienti Tsutsugamushi Co-Infection From a Tertiary Care Center in South India

Abstract

BackgroundConcurrent infection with multiple pathogens is common in tropics, posing diagnostic and treatment challenges. Although co-infections of dengue, malaria, leptospirosis and typhoid in various combinations have been described, data on dengue and scrub typhus co-infection is distinctly limited.MethodologyThis study was a retrospective analysis of dengue and scrub typhus co-infection diagnosed between January 2010 and July 2014 at a tertiary care center. Clinical and laboratory features of these cases were compared with age and gender-matched patients with isolated dengue fever and isolated scrub typhus. Positive test for dengue non-structural 1 (NS1) antigen was considered diagnostic of dengue whereas scrub typhus was diagnosed by IgM scrub antibodies demonstrated by ELISA.ResultsThere were 6 cases of dengue-scrub co-infection during the review period which fitted clinical and laboratory profile with a mean age of 42.5 years. Fever, headache, and arthralgia were common. Normal hemoglobin, significant thrombocytopenia, transaminitis, and hypoalbuminemia were identified in these patients. Compared to patients with isolated dengue, those with co-infection had higher pulse rate, lower systolic blood pressure, normal leucocyte counts, higher levels of liver enzymes, greater prolongation of partial thromboplastin time (aPTT) and lower serum albumin. Co-infection was characterized by a lower nadir platelet count compared to scrub typhus, and lesser time to nadir platelet count and longer duration of hospital stay compared to either isolated dengue or scrub typhus.ConclusionDengue-scrub typhus co-infection may be under-diagnosed in tropics, particularly confounded during dengue epidemics. Normal leukocyte counts, early drop in platelets and hypoalbuminemia in dengue patients could be clues to concurrent scrub typhus infection. Prompt recognition and treatment of scrub typhus in such cases may reduce unnecessary hospital stay and cost.

Dengue and Scrub Typhus Coinfection in a Patient Presenting with Febrile Illness

“…It is prudent to check for HIV, HBsAg, and HCV in an adult presenting with febrile illness and it is done routinely for admitted cases at our centre. Marked thrombocytopenia, significantly high AST and ALT, and low albumin have been described in coinfections [2]. Oral doxycycline was given at the time of admission with high degree of suspicion for scrub typhus and was still continued after dengue tests came positive.…”

“…Both diseases have several clinical and laboratory features in common, including rash, thrombocytopenia, and hepatic dysfunction. However, concurrent infection with both pathogens is exceedingly rare, primarily due to the different vectors involved [2]. Here we present a case report of 50-year-old female with acute febrile illness from southern belt of Nepal.…”

Clinical and Hematological Profile of Patients With Dengue Fever at a Tertiary Care Hospital – An Observational Study

“…5 The risk of severe bleeding in dengue is much higher with a secondary infection and is seen in about 2–4% of cases having secondary infection. 6 , 7 , 8 , 9 Atypical presentations are also encountered with acute liver failure, encephalopathy with seizures, renal dysfunction, lower gastrointestinal bleeding. 10 Several studies have previously analyzed the clinico-epidemiologic profile of dengue infection.…”

Concurrent Coinfections in Tropics: A Hospital-Based Observational Study from Himachal Pradesh, India

“…Malaria, dengue, and chikungunya are the most common coinfections reported from India [17]. Scrub typhus, malaria, dengue fever, and leptospirosis coinfections have been reported from Himachal Pradesh, Uttarakhand, central India, Puducherry, and also from other parts of India [2,[18][19][20][21][22]. The prevalence of coinfections among patients with AUF was 1.39% in this study.…”