Original Articles
Vol. 8 (2016): Review, Original Articles, Case Reports
https://doi.org/10.4084/mjhid.2016.028

CLINICAL AND LABORATORY CHARACTERISTICS OF DENGUE-ORIENTI TSUTSUGAMUSHI CO-INFECTION FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: February 28, 2016
Accepted: May 17, 2016
Published: June 16, 2016
6380
Views
888
Downloads
1469
HTML
co-infection, dengue, scrub typhus, O.tsutsugamushi, thrombocytopenia
Internal medicine, Hematology, infectious diseases

Authors

Aneesh Basheer
basheeraneesh@gmail.com
Pondicherry Institute of Medical Sciences, India.
Nayyar Iqbal
Pondicherry Institute of Medical Sciences, India.
Sudhagar Mookkappan
Pondicherry Institute of Medical Sciences, India.
Patricia Anitha
Pondicherry Institute of Medical Sciences, India.
Shashikala Nair
Pondicherry Institute of Medical Sciences, India.
Reba Kanungo
Pondicherry Institute of Medical Sciences, India.
Ravichandran Kandasamy
Pondicherry Institute of Medical Sciences, India.

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 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 haemoglobin, 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 leucocyte 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.

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Isaac R, Varghese GM, Mathai EJM, Joseph I. Scrub typhus: prevalence and diagnostic issues in rural SouthernIndia. Clin Infect Dis 2004; 39(9): 1395–1396.
Yong L, Koh K. A Case of Mixed Infections in a Patient Presenting with Acute Febrile Illness in the Tropics. Case Reports in Infectious Diseases Volume 2013, Article ID 562175, 3 pages.
Yukti Sharma, Vandanaarya, Sanjay Jain, Manoj Kumar, LopamudraDeka, Anjali Mathur. Dengue and Typhoid Co-infection– Study from a Government Hospital in North Delhi. Journal of Clinical and Diagnostic Research. 2014 Dec, Vol-8(12): DC09-DC11
Iqbal N, Viswanathan S, Remalayam B, Vivekanandan M, George T. T Pancreatitis and MODS Due to Scrub Typhus and Dengue Co-Infection. Tropical Medicine and Health. 2012; 40(1) pp. 19-21.
Jyothi P, Metri B. Correlation of serological markers and platelet count in the diagnosis of Dengue virus infection.Adv Biomed Res. 2015; 4: 26. doi: 10.4103/2277-9175.150396
Vivekanandan M, Mani A, Priya Y, Singh A, Jayakumar S, Purty S. Outbreak of Scrub Typhus in Pondicherry. J Assoc Physicians India. 2010;58:24 - 28.
Funahara Y, Ogawa K, Fujita N, Okuno Y. Three possible triggers to induce thrombocytopenia in dengue virus infection. Southeast Asian J Trop Med Public Health, 1987;18(3):351-5.
Basheer A, Padhi S, Boopathy V, Mallick S, Nair S, Varghese RG, Kanungo R. Hemophagocytic Lymphohistiocytosis: an Unusual Complication of Orientia tsutsugamushi Disease (Scrub Typhus). Mediterr J Hematol Infect Dis 2015, 7(1): e2015008, DOI:http://dx.doi.org/10.4084/MJHID.2015.008
García S, Morales R, Hunter RF. Dengue fever with thrombocytopenia: studies towards defining vulnerability of bleeding. Bol Asoc Med P R. 1995;87(1-2):2-7.
Tristão-Sá R, Kubelka C, Zandonade E, Zagne SM, Rocha N, Zagne L, AraújoN,etal.Clinical and hepatic evaluation in adult dengue patients:a prospective two-month cohort study. Revista da SociedadeBrasileira de Medicina Tropical. 2012; 45(6):675-681.
Hu M, Liu J, Wu K, Lu S, Chiou S, Kuo C, Chuah S, Et Al. Short Report: Abnormal Liver Function In Scrub Typhus. Am. J. Trop. Med. Hyg,2005;73(4), Pp. 667–668
Kim D, Kim S, Choi S, Yun N. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis. 2010;10(1):108.
Ho T, Wang S, Lin Y, Liu C. Clinical and laboratory predictive markers for acute dengue infection. Journal of Biomedical Science 2013; 20:75.
Susheel Kumar, P. Sathish Kumar, Gurmeet Kaur, Ashish Bhalla, Navneet Sharma & Subhash Varma. Rare concurrent infection with scrub typhus, dengue and malaria in a young female J Vector Borne Dis 2014; 51,March, pp. 71–72
Kulkarni R D, Patil S S, Ajantha G S, Upadhya A K, Kalabhavi A S, Shubhada R M, Shetty P C, Jain P A. Association of platelet count and serological markers of dengue infection- importance of NS1 antigen. Indian J Med Microbiol 2011;29:359-62
Prakash JA, Abraham OC, Mathai E. Evaluation of tests for serological diagnosis of scrub typhus. Trop Doct. 2006 Oct;36(4):212-3.

Ethics Approval

Original Articles

Supporting Agencies

None
Aneesh Basheer, Pondicherry Institute of Medical Sciences
Associate Professor of Medicine
Nayyar Iqbal, Pondicherry Institute of Medical Sciences
Assistant Professor of Medicine
Sudhagar Mookkappan, Pondicherry Institute of Medical Sciences
Associate Professor of Medicine
Patricia Anitha, Pondicherry Institute of Medical Sciences
Assistant Professor of Microbiology
Shashikala Nair, Pondicherry Institute of Medical Sciences
Professor of Microbiology
Reba Kanungo, Pondicherry Institute of Medical Sciences
Professor and Head of Microbiology
Ravichandran Kandasamy, Pondicherry Institute of Medical Sciences
Assistant Professor of Biostatistics

How to Cite



“CLINICAL AND LABORATORY CHARACTERISTICS OF DENGUE-ORIENTI TSUTSUGAMUSHI CO-INFECTION FROM A TERTIARY CARE CENTER IN SOUTH INDIA” (2016) Mediterranean Journal of Hematology and Infectious Diseases, 8, p. e2016028. doi:10.4084/mjhid.2016.028.