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Clinical and Laboratory Characteristics of Dengue-Orientia tsutsugamushi co-Infection from a Tertiary Care Center in South India.
Mediterr J Hematol Infect Dis 2016; 8(1):e2016028MJ

Abstract

BACKGROUND

Concurrent 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.

METHODOLOGY

This 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.

RESULTS

There 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.

CONCLUSION

Dengue-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.

Authors+Show Affiliations

Department of General Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014.Department of General Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014.Department of General Medicine, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014.Department of Microbiology, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014.Department of Microbiology, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014.Department of Microbiology, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014.Department of Biostatistics, Pondicherry Institute of Medical Sciences, Ganapathichettikulam, Kalapet, Pondicherry - 605014.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27413521

Citation

Basheer, Aneesh, et al. "Clinical and Laboratory Characteristics of Dengue-Orientia Tsutsugamushi co-Infection From a Tertiary Care Center in South India." Mediterranean Journal of Hematology and Infectious Diseases, vol. 8, no. 1, 2016, pp. e2016028.
Basheer A, Iqbal N, Mookkappan S, et al. Clinical and Laboratory Characteristics of Dengue-Orientia tsutsugamushi co-Infection from a Tertiary Care Center in South India. Mediterr J Hematol Infect Dis. 2016;8(1):e2016028.
Basheer, A., Iqbal, N., Mookkappan, S., Anitha, P., Nair, S., Kanungo, R., & Kandasamy, R. (2016). Clinical and Laboratory Characteristics of Dengue-Orientia tsutsugamushi co-Infection from a Tertiary Care Center in South India. Mediterranean Journal of Hematology and Infectious Diseases, 8(1), pp. e2016028. doi:10.4084/MJHID.2016.028.
Basheer A, et al. Clinical and Laboratory Characteristics of Dengue-Orientia Tsutsugamushi co-Infection From a Tertiary Care Center in South India. Mediterr J Hematol Infect Dis. 2016;8(1):e2016028. PubMed PMID: 27413521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and Laboratory Characteristics of Dengue-Orientia tsutsugamushi co-Infection from a Tertiary Care Center in South India. AU - Basheer,Aneesh, AU - Iqbal,Nayyar, AU - Mookkappan,Sudhagar, AU - Anitha,Patricia, AU - Nair,Shashikala, AU - Kanungo,Reba, AU - Kandasamy,Ravichandran, Y1 - 2016/06/16/ PY - 2016/02/28/received PY - 2016/05/17/accepted PY - 2016/7/15/entrez PY - 2016/7/15/pubmed PY - 2016/7/15/medline SP - e2016028 EP - e2016028 JF - Mediterranean journal of hematology and infectious diseases JO - Mediterr J Hematol Infect Dis VL - 8 IS - 1 N2 - BACKGROUND: Concurrent 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. METHODOLOGY: This 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. RESULTS: There 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. CONCLUSION: Dengue-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. SN - 2035-3006 UR - https://www.unboundmedicine.com/medline/citation/27413521/Clinical_and_Laboratory_Characteristics_of_Dengue_Orientia_tsutsugamushi_co_Infection_from_a_Tertiary_Care_Center_in_South_India_ L2 - https://doi.org/10.4084/MJHID.2016.028 DB - PRIME DP - Unbound Medicine ER -