Clinical Characteristics and Risk Factors for Concurrent Bacteremia in Adults With Dengue Hemorrhagic Fever

Abstract

To better understand the clinical characteristics of concurrent bacteremia (dual infection) in patients with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) and identify predictive risk factors for dual infection, 100 patients with DHF/DSS (7 with a dual infection and 93 with DHF/DSS alone [controls]) were enrolled in this study. A patient with DHF/DSS who lacked three or more of the five most frequently observed manifestations other than fever in controls or showed disturbed consciousness was defined as one with unusual dengue manifestations. Patients with a dual infection were older, and tended to have prolonged fever, higher frequencies of acute renal failure, gastrointestinal bleeding, altered consciousness, unusual dengue manifestations, and DSS. Acute renal failure (odds ratio [OR] = 51.45, P = 0.002), and prolonged fever (> 5 days) (OR = 26.07, P = 0.017) were independent risk factors for dual infection. Clinicians should be alert to the potential for concurrent bacteremia when treating patients with DHF/DSS who are at risk for dual infection and manage them accordingly.

Prevalencia y curso clínico de la infección por dengue en adultos mayores con cuadro febril agudo en un hospital de alta complejidad en Cali, Colombia

“…En el presente estudio se encontró infección bacteriana concomitante en tres pacientes (8 %), lo cual es similar a lo reportado en series del sudeste asiático en donde los pacientes que desarrollaron infecciones asociadas a la atención en salud también presentaron neutrofilia (19,21,25). Otra complicación que se reporta con frecuencia en esta población es la falla renal aguda, aunque en este estudio solo tres pacientes presentaron esta condición y requirieron internación en la unidad de cuidados intensivos (19).…”

“…Se ha determinado, asimismo, que tanto los niveles de carga viral como de antígeno NS1 se correlacionan con el daño endotelial y las hemorragias graves en el dengue (25,(30)(31)(32).…”

Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

“…Strengths of the study include large sample size and use of multivariable analysis for relatively uncommon events, such as dengue dual infection. Prior studies were relatively smaller, 22,24 which would preclude such an investigation. All diagnoses of dengue infection were laboratory-confirmed.…”

“…22 In a prior series of 100 patients with dengue hemorrhagic fever or dengue shock syndrome, 7 (7%) patients had concurrent bacteremia. 22 In contrast, among all our patients with laboratory-confirmed dengue, 25 (1.2%) patients had concurrent bacteremia, and 83 (4.0%) patients had bacterial coinfection, which agrees more closely with the 3.6% bacterial infection rate among 606 adult dengue patients in another study.…”

“…22 Primary gram-negative bacteremia was postulated to be caused by the breakdown of the intestinal mucosal barrier in severe dengue infections. 22 We additionally observed a broad range of other infections, such as cellulitis and cholecystitis (with potential secondary infection), that have been highlighted in case reports. 23,24 However, we cannot exclude the possibility that bacterial infection may also increase susceptibility to dengue infection.…”