Dengue and leptospirosis coinfection: a case series.
Case report
Coinfection
Dengue fever
Encephalopathy
Leptospirosis
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
07 Aug 2024
07 Aug 2024
Historique:
received:
06
03
2024
accepted:
22
06
2024
medline:
7
8
2024
pubmed:
7
8
2024
entrez:
6
8
2024
Statut:
epublish
Résumé
Both dengue and Leptospira infections are endemic to tropical and subtropical regions, with their prevalence increasing in recent decades. Coinfection with these pathogens presents significant diagnostic challenges for clinicians due to overlapping clinical manifestations and laboratory findings. This case report aims to elucidate two clinical scenarios where the coinfection of dengue and leptospirosis complicates the disease course, creating a diagnostic conundrum. We present the clinical scenarios of two Bangladeshi males, aged 25 and 35 years, who were admitted to our hospital with acute febrile illness. The first patient exhibited hepatic and renal involvement, while the second presented with symptoms initially suggestive of meningoencephalitis. Both cases were initially managed under the presumption of dengue infection based on positive serology. However, further evaluation revealed coinfection with Leptospira, complicating the disease course. Both patients received appropriate treatment for dengue and antibacterial therapy for leptospirosis, ultimately resulting in their recovery. These case scenarios underscore the critical importance for clinicians in regions where dengue and Leptospira are endemic to consider both diseases when evaluating patients presenting with acute febrile illness.
Sections du résumé
BACKGROUND
BACKGROUND
Both dengue and Leptospira infections are endemic to tropical and subtropical regions, with their prevalence increasing in recent decades. Coinfection with these pathogens presents significant diagnostic challenges for clinicians due to overlapping clinical manifestations and laboratory findings. This case report aims to elucidate two clinical scenarios where the coinfection of dengue and leptospirosis complicates the disease course, creating a diagnostic conundrum.
CASE PRESENTATION
METHODS
We present the clinical scenarios of two Bangladeshi males, aged 25 and 35 years, who were admitted to our hospital with acute febrile illness. The first patient exhibited hepatic and renal involvement, while the second presented with symptoms initially suggestive of meningoencephalitis. Both cases were initially managed under the presumption of dengue infection based on positive serology. However, further evaluation revealed coinfection with Leptospira, complicating the disease course. Both patients received appropriate treatment for dengue and antibacterial therapy for leptospirosis, ultimately resulting in their recovery.
CONCLUSION
CONCLUSIONS
These case scenarios underscore the critical importance for clinicians in regions where dengue and Leptospira are endemic to consider both diseases when evaluating patients presenting with acute febrile illness.
Identifiants
pubmed: 39107781
doi: 10.1186/s13256-024-04675-0
pii: 10.1186/s13256-024-04675-0
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
370Informations de copyright
© 2024. The Author(s).
Références
Who.int. [cited 2024 Feb 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue .
Abid MA, Abid MB. Climate change and the increased burden of dengue fever in Pakistan. Lancet Infect Dis. 2023;23(1):17–8. https://doi.org/10.1016/s1473-3099(22)00808-8 .
doi: 10.1016/s1473-3099(22)00808-8
pubmed: 36480945
Kakarla SG, Bhimala KR, Kadiri MR, Kumaraswamy S, Mutheneni SR. Dengue situation in India: suitability and transmission potential model for present and projected climate change scenarios. Sci Total Environ. 2020;739(140336):140336. https://doi.org/10.1016/j.scitotenv.2020.140336 .
doi: 10.1016/j.scitotenv.2020.140336
pubmed: 32758966
Healthcare workers. Cdc.gov. 2023 [cited 2024 Feb 23]. Available from: https://www.cdc.gov/leptospirosis/health_care_workers/index.html .
Chen I-C, Hill JK, Ohlemüller R, Roy DB, Thomas CD. Rapid range shifts of species associated with high levels of climate warming. Science. 2011;333(6045):1024–6. https://doi.org/10.1126/science.1206432 .
doi: 10.1126/science.1206432
pubmed: 21852500
Chadsuthi S, Chalvet-Monfray K, Wiratsudakul A, Modchang C. The effects of flooding and weather conditions on leptospirosis transmission in Thailand. Sci Rep. 2021. https://doi.org/10.1038/s41598-020-79546-x .
doi: 10.1038/s41598-020-79546-x
pubmed: 33452273
pmcid: 7810882
Sethi S, Mishra B, Singhal L, Ratho R. Leptospirosis coexistent with dengue fever: a diagnostic dilemma. J Glob Infect Dis. 2013;5(3):121. https://doi.org/10.4103/0974-777x.116878 .
doi: 10.4103/0974-777x.116878
pubmed: 24049369
pmcid: 3766336
Sachu A, Madhavan A, Vasudevan A, Vasudevapanicker J. Prevalence of dengue and leptospirosis co-infection in a tertiary care hospital in south India. Iran J Microbiol. 2018;10(4):227–32.
pubmed: 30483374
pmcid: 6243148
Suppiah J, Chan S-Y, Ng M-W, Khaw Y-S, Ching S-M, Mat-Nor LA, et al. Clinical predictors of dengue fever co-infected with leptospirosis among patients admitted for dengue fever—a pilot study. J Biomed Sci. 2017. https://doi.org/10.1186/s12929-017-0344-x .
doi: 10.1186/s12929-017-0344-x
pubmed: 28659189
pmcid: 5488303
del Valle-Mendoza J, Palomares-Reyes C, Carrillo-Ng H, Tarazona-Castro Y, Kym S, Aguilar-Luis MA, et al. Leptospirosis in febrile patients with suspected diagnosis of dengue fever. BMC Res Notes. 2021. https://doi.org/10.1186/s13104-021-05627-3 .
doi: 10.1186/s13104-021-05627-3
pubmed: 34758882
pmcid: 8579657
Bruce MG, Sanders EJ, Leake JAD, Zaidel O, Bragg SL, Aye T, et al. Leptospirosis among patients presenting with dengue-like illness in Puerto Rico. Acta Trop. 2005;96(1):36–46. https://doi.org/10.1016/j.actatropica.2005.07.001 .
doi: 10.1016/j.actatropica.2005.07.001
pubmed: 16083836
Gov.bd. [cited 2024 Feb 23]. Available from: https://old.dghs.gov.bd/images/docs/vpr/20231208_dengue_all.pdf .
Victoriano AFB, Smythe LD, Gloriani-Barzaga N, Cavinta LL, Kasai T, Limpakarnjanarat K, et al. Leptospirosis in the Asia Pacific region. BMC Infect Dis. 2009. https://doi.org/10.1186/1471-2334-9-147 .
doi: 10.1186/1471-2334-9-147
pubmed: 19732423
pmcid: 2749047
Bhaskaran D, Chadha SS, Sarin S, Sen R, Arafah S, Dittrich S. Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review. BMC Infect Dis. 2019. https://doi.org/10.1186/s12879-019-4589-8 .
doi: 10.1186/s12879-019-4589-8
pubmed: 31722678
pmcid: 6854686
Wangdi K, Kasturiaratchi K, Nery SV, Lau CL, Gray DJ, Clements ACA. Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in south and Southeast Asia: a systematic review. BMC Infect Dis. 2019. https://doi.org/10.1186/s12879-019-4185-y .
doi: 10.1186/s12879-019-4185-y
pubmed: 31272417
pmcid: 6610835
Das P, Rahman MZ, Banu S, Rahman M, Chisti MJ, Chowdhury F, et al. Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic. PLoS ONE. 2022;17(9):e0273902. https://doi.org/10.1371/journal.pone.0273902 .
doi: 10.1371/journal.pone.0273902
pubmed: 36048788
pmcid: 9436081
Dengue—Bangladesh. Who.int. [cited 2024 Feb 23]. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON481 .
Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis. 2015;9(9):e0003898. https://doi.org/10.1371/journal.pntd.0003898 .
doi: 10.1371/journal.pntd.0003898
pubmed: 26379143
pmcid: 4574773
Garba B, Bahaman AR, Bejo SK, Zakaria Z, Mutalib AR, Bande F. Major epidemiological factors associated with leptospirosis in Malaysia. Acta Trop. 2018;178:242–7. https://doi.org/10.1016/j.actatropica.2017.12.010 .
doi: 10.1016/j.actatropica.2017.12.010
pubmed: 29217379
Antima, Banerjee S. Modeling the dynamics of leptospirosis in India. Sci Rep. 2023. https://doi.org/10.1038/s41598-023-46326-2 .
doi: 10.1038/s41598-023-46326-2
pubmed: 37957218
pmcid: 10643689
Solomon T, Dung NM, Vaughn DW, Kneen R, Thao LTT, Raengsakulrach B, et al. Neurological manifestations of dengue infection. Lancet. 2000;355(9209):1053–9. https://doi.org/10.1016/s0140-6736(00)02036-5 .
doi: 10.1016/s0140-6736(00)02036-5
pubmed: 10744091
Cam BV, Heegaard ED, Poulsen A, Hue NB, Fonsmark L, Phuong NT. Prospective case-control study of encephalopathy in children with dengue hemorrhagic fever. Am J Trop Med Hygiene. 2001;65(6):848–51. https://doi.org/10.4269/ajtmh.2001.65.848 .
doi: 10.4269/ajtmh.2001.65.848
Vasanthapuram R, Shahul Hameed SK, Desai A, Mani RS, Reddy V, Velayudhan A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a four year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis. 2019;84:S19-24. https://doi.org/10.1016/j.ijid.2019.01.008 .
doi: 10.1016/j.ijid.2019.01.008
Voon V, Saiva L, Prendiville B, Brennan D, Dodd J, McCreery C. Leptospiral myocarditis—a rare assault on myocardium. Int J Cardiol. 2014;172(1):e76–8. https://doi.org/10.1016/j.ijcard.2013.12.046 .
doi: 10.1016/j.ijcard.2013.12.046
pubmed: 24411208
Rajapakse S, Rodrigo C, Balaji K, Fernando SD. Atypical manifestations of leptospirosis. Trans R Soc Trop Med Hyg. 2015;109(5):294–302. https://doi.org/10.1093/trstmh/trv026 .
doi: 10.1093/trstmh/trv026
pubmed: 25813883
Chakurkar G, Vaideeswar P, Pandit SP, Divate SA. Cardiovascular lesions in leptospirosis: an autopsy study. J Infect. 2008;56(3):197–203. https://doi.org/10.1016/j.jinf.2007.12.007 .
doi: 10.1016/j.jinf.2007.12.007
pubmed: 18262280
Farrukh AM, Ganipineni VDP, Jindal U, Chaudhary A, Puar RK, Ghazarian K, et al. Unveiling the dual threat: myocarditis in the spectrum of dengue fever. Curr Probl Cardiol. 2024;49(1):102029. https://doi.org/10.1016/j.cpcardiol.2023.102029 .
doi: 10.1016/j.cpcardiol.2023.102029
pubmed: 37567490
Pérez Rodríguez NM, Torres JV, Sharp TM, Bower WA, Rivera A, Zaki SR, et al. Case series of fatal Leptospira spp./dengue virus co-infections—Puerto Rico, 2010–2012. Am J Trop Med Hygiene. 2014;91(4):760–5. https://doi.org/10.4269/ajtmh.14-0220 .
doi: 10.4269/ajtmh.14-0220
Dircio Montes Sergio A, González Figueroa E, María Saadia VG, Elizabeth SH, Beatriz RS, Altuzar Aguilar Víctor M, et al. Leptospirosis prevalence in patients with initial diagnosis of dengue. J Trop Med. 2012;2012:1–5. https://doi.org/10.1155/2012/519701 .
doi: 10.1155/2012/519701
Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218–35. https://doi.org/10.1016/j.jclinepi.2017.04.026 .
doi: 10.1016/j.jclinepi.2017.04.026
pubmed: 28529185