Clinical predictors of dengue fever co-infected with leptospirosis among patients admitted for dengue fever – a pilot study

Abstract

BackgroundDengue and leptospirosis infections are currently two major endemics in Malaysia. Owing to the overlapping clinical symptoms between both the diseases, frequent misdiagnosis and confusion of treatment occurs. As a solution, the present work initiated a pilot study to investigate the incidence related to co-infection of leptospirosis among dengue patients. This enables the identification of more parameters to predict the occurrence of co-infection.MethodTwo hundred sixty eight serum specimens collected from patients that were diagnosed for dengue fever were confirmed for dengue virus serotyping by real-time polymerase chain reaction. Clinical, laboratory and demographic data were extracted from the hospital database to identify patients with confirmed leptospirosis infection among the dengue patients. Thus, frequency of co-infection was calculated and association of the dataset with dengue-leptospirosis co-infection was statistically determined.ResultsThe frequency of dengue co-infection with leptospirosis was 4.1%. Male has higher preponderance of developing the co-infection and end result of shock as clinical symptom is more likely present among co-infected cases. It is also noteworthy that, DENV 1 is the common dengue serotype among all cases identified as dengue-leptospirosis co-infection in this study.ConclusionThe increasing incidence of leptospirosis among dengue infected patients has posed the need to precisely identify the presence of co-infection for the betterment of treatment without mistakenly ruling out either one of them. Thus, anticipating the possible clinical symptoms and laboratory results of dengue-leptospirosis co-infection is essential.

Rapid, actionable diagnosis of urban epidemic leptospirosis using a pathogenic Leptospira lipL32-based real-time PCR assay

“…Leptospirosis was excluded based on culture and MAT results. However, since both leptospirosis and dengue are endemic in Salvador and both patients had less than 7 days with symptoms, it is possible that they were infected with both pathogens as has been previously demonstrated in other locations [ 37 , 38 ].…”

Leptospira interrogans and Leptospira kirschneri are the dominant Leptospira species causing human leptospirosis in Central Malaysia

“…Dengue is highly endemic in Malaysia with a minimum of 100,000 cases and more than 200 mortalities every year [44]. A recent study by Suppiah et al (2017) reported 11/268 (4.1%) dengue cases to be co-infected with leptospirosis [45]. Although leptospirosis is endemic in Malaysia, the lack of clinical awareness and the evaluation of co-infection with dengue is often neglected, hence delays the appropriate management.…”

Leptospirosis among Returned Travelers: A GeoSentinel Site Survey and Multicenter Analysis—1997–2016

“…Given the laboratory diagnostic challenges and nonspecific presentation of many clinically evident cases, the burden of reported disease is likely underestimated, as supported by other published data. 1,[18][19][20] We recommend enhancement of awareness about leptospirosis and heightened clinical suspicion when evaluating the ill traveler. Laboratories need to have up-to-date diagnostic methods available; molecular detection techniques are key to early diagnosis, which is helpful for the early initiation of treatment that may substantially reduce morbidity and improve outcomes.…”

“…13 The list of differential diagnoses for the evaluating clinician to consider is long, encompassing, among others, malaria, arboviral infections, rickettsial diseases, and typhoid fever, 13,17 and misdiagnosis is common. 6,[18][19][20] Early recognition and treatment may be essential to improve patient outcomes 13,21,22 and minimize hospitalization costs.…”