Fatal leptospirosis and chikungunya co-infection: Do not forget leptospirosis during chikungunya outbreaks

Abstract

In endemic areas, leptospirosis can be missed by erroneous clinical or laboratory diagnosis of arboviroses or co-infections with arboviruses and an increase in mortality due to leptospirosis has already been reported during arboviruses outbreaks. During the French Polynesian chikungunya virus outbreak in 2014–2015, two leptospirosis and chikungunya co-infections were reported, one of which was fatal. Diagnosis of leptospiroses was delayed in the context of chikungunya outbreak. In the context of arbovirus outbreak, the risk of misdiagnosis of leptospirosis is maximum and clinicians should initiate early antibiotic therapy if leptospirosis is suspected. A delayed diagnosis of leptospirosis can be responsible for fatal outcome. Leptospirosis should be considered even if dengue or chikungunya virus infections are confirmed by reference molecular testing

Pneumonia in the tropics

“…51 Interestingly, leptospirosis and chikungunya coinfection can potentially lead to a delayed diagnosis and subsequent deleterious outcomes. Nhan et al 52 described a fatal case of leptospirosis and chikungunya co-infection in a French-Polynesian outbreak during the rainy season, where diagnosis was delayed due to overlapping symptoms. Co-infections with dengue have also been described by Pan et al, where three cases of co-infection were detected during a dengue outbreak.…”

Fatal Dengue, Chikungunya and Leptospirosis Co-Infection: The Febrile Patient in Tropical Areas, Importance of Co-Infection Assessment

“…The clinical challenge remains complex and it can turn even more difficult since the risk of introduction and emergence of other infectious disease in different territories continue to exist. As has been recently suggested [8], during arboviruses outbreaks, including dengue, chikungunya and Zika (as is currently happening in different countries of the Americas), the attack rate of infections is usually high, especially when it occurs in a population with low levels or no pre-existing immunity.…”

“…Outbreaks of leptospirosis and malaria concurrent to dengue outbreaks have been reported [14], and although co-infections were rare (<1%), previous reports have showed the evolution to fatal disease of coinfections of Leptospira spp. with arboviruses [6][7][8]15],…”

“…However, reports of 2 of 6 simultaneous infections with arbovirus and other microorganisms like Leptospira spp. have evolved to death [6][7][8]. Hence, co-circulation with other endemic bacteria and protozoa makes difficult and necessary the laboratory etiological assessment of febrile patients in tropical settings.…”

Análise da leptospirose no estado do Paraná no período de 2010 a 2015

“…São nos períodos chuvosos que a cautela tem que ser intensificada, pois os riscos de enchentes são maiores. Nhan et al (2016), afirmam que no período chuvoso e de enchentes há o aumento de casos de leptospirose. Outrossim, os cuidados devem ser mantidos, por que quando ocorre a contaminação dos seres humanos o diagnóstico clínico não é fácil (MONARIS, 2015), pois à variedade de sintomas e, também pelo fato de haver semelhanças à outras doenças tropicais.…”