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Trop Med Infect Dis. 2018 Nov 26;3(4). pii: E123. doi: 10.3390/tropicalmed3040123.

Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas.

Author information

1
Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira 66003, Colombia. jaancardona@utp.edu.co.
2
Infection and Immunity Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira 66003, Colombia. jaancardona@utp.edu.co.
3
Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira 66003, Colombia. caedjimenez@utp.edu.co.
4
Infection and Immunity Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira 66003, Colombia. caedjimenez@utp.edu.co.
5
Secretary of Health of Ibagué, Ibague, Tolima 730001, Colombia. caedjimenez@utp.edu.co.
6
Secretary of Health of Ibagué, Ibague, Tolima 730001, Colombia. herivasquez@gmail.com.
7
School of Medicine, Faculty of Health Sciences, Universidad de Tolima, Ibagué, Tolima 730001, Colombia. jaancardona@gmail.com.
8
Secretary of Health of Tolima, Ibague, Tolima 730001, Colombia. okdjx@hotmail.com.
9
School of Medicine, Faculty of Health Sciences, Universidad de Tolima, Ibagué, Tolima 730001, Colombia. arodriguez@jidc.org.
10
Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira 66003, Colombia. arodriguezm@utp.edu.co.
11
Medical School, Universidad Privada Franz Tamayo UNIFRAZ, Cochabamba 4780, Bolivia. arodriguezm@utp.edu.co.

Abstract

The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.

KEYWORDS:

Colombia; Latin America; Leptospira; chikungunya; co-infection; dengue

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