Concurrent dengue and typhoid infection: study from a tertiary care centre in Muzaffarnagar, India

Background: Acute febrile illness is a common presenting complaint during the rainy season. Rains predispose to both water and vector borne diseases. Co-infection of dengue with malaria, leptospirosis, typhoid, scrub typhus and other arboviral diseases can occur in endemic areas. Such dual infections are difficult to diagnose and create a diagnostic dilemma for the treating physician. Here in this study authors attempt to find out rates of concurrent dengue and typhoid infection.Methods: This retrospective study was done between August to November 2017. 403 patients presenting with acute febrile illness were studied. Diagnosis of dengue was done by rapid card test detecting NS1 antigen, IgM and IgG antibodies. Serodiagnosis of Salmonella infection was done by tube Widal test.Results: : Out of 403 febrile sera samples tested 154 (38.2%) were positive for dengue (either NS1 antigen or IgM antibodies or both), 71(17.6%) were positive for Widal test O and H titres ≥1:160) and 28 (6.9%) were positive for both dengue as well as Salmonella (Widal test).Conclusions: Acute febrile illnesses with diagnostic dilemma may be seen in cases of co-infection. Only better clinical judgement and right choice of laboratory tests can diagnose these diseases timely and prevent fatal outcomes.

A review of concurrent infections of malaria and dengue in Asia

Concurrent infections of malaria and dengue are when both of these mosquito-borne diseases occur simultaneously in an individual. In this review, reported cases with these co-infections in Asia are discussed. The focus is on the overlapping clinical presentations and the difficulties encountered in differential diagnosis. Also, cases reported in some special conditions, viz., pregnancy, foetal infections, and co-infections with one or more other infectious agents are highlighted. Due to similar clinical presentations of malaria and dengue, these co-infections may give rise to an incorrect diagnosis. Moreover, the treatment regimens for these co-infections are not the same as those for mono-infections. Hence, a delay in implementing the appropriate treatment regimen for these concurrent infections due to poor diagnosis can be fatal. The present review is intended to increase awareness about the clinical significance and the importance of these co-infections among clinicians, public health workers and health authorities in the Asian region. Though malaria-dengue concurrent infections are seldom reported from the Asian region, it is probably increasing particularly in the countries known to be endemic for both of the above diseases. A compulsory reporting of the incidences of malaria-dengue concurrent infections is recommended.

A review of concurrent infections of malaria and dengue in Asia

Concurrent infections of malaria and dengue are when both of these mosquito-borne diseases occur simultaneously in an individual. In this review, reported cases with these co-infections in Asia are discussed. The focus is on the overlapping clinical presentations and the difficulties encountered in differential diagnosis. Also, cases reported in some special conditions, viz., pregnancy, foetal infections, and co-infections with one or more other infectious agents are highlighted. Due to similar clinical presentations of malaria and dengue, these co-infections may give rise to an incorrect diagnosis. Moreover, the treatment regimens for these co-infections are not the same as those for mono-infections. Hence, a delay in implementing the appropriate treatment regimen for these concurrent infections due to poor diagnosis can be fatal. The present review is intended to increase awareness about the clinical significance and the importance of these co-infections among clinicians, public health workers and health authorities in the Asian region. Though malaria-dengue concurrent infections are seldom reported from the Asian region, it is probably increasing particularly in the countries known to be endemic for both of the above diseases. A compulsory reporting of the incidences of malaria-dengue concurrent infections is recommended.

Genetic diversity of dengue virus serotypes 1 and 2 in the State of Paraná, Brazil, based on a fragment of the capsid/premembrane junction region / Diversidade genética dos vírus dengue sorotipos 1 e 2, no Estado do Paraná, Brasil, baseada no fragmento da junção do gene capsídeo/pré-membrana

INTRODUCTION: The precise identification of the genetic variants of the dengue virus is important to understand its dispersion and virulence patterns and to identify the strains responsible for epidemic outbreaks. This study investigated the genetic variants of the capsid-premembrane junction region fragment in the dengue virus serotypes 1 and 2 (DENV1-2). METHODS: Samples from 11 municipalities in the State of Paraná, Brazil, were provided by the Central Laboratory of Paraná. They were isolated from the cell culture line C6/36 (Aedes albopictus) and were positive for indirect immunofluorescence. Ribonucleic acid (RNA) extracted from these samples was submitted to the reverse transcription polymerase chain reaction (RT-PCR) and nested PCR. RESULTS: RT-PCR revealed that 4 of the samples were co-infected with both serotypes. The isolated DENV-1 sequences were 95-100% similar to the sequences of other serotype 1 strains deposited in GenBank. Similarly, the isolated DENV-2 sequences were 98-100% similar to other serotype 2 sequences in GenBank. According to our neighbor-joining tree, all strains obtained in this study belonged to genotype V of DENV-1. The DENV-2 strains, by contrast, belonged to the American/Asian genotypes. CONCLUSIONS: The monitoring of circulating strains is an important tool to detect the migration of virus subtypes involved in dengue epidemics.

INTRODUÇÃO:A identificação precisa da variante genética do vírus da dengue é importante para compreender a dispersão, virulência e identificação das cepas responsáveis pelas epidemias. O objetivo da pesquisa foi investigar a variação genética do fragmento da junção do gene capsídeo/pré-membrana dos sorotipos 1 e 2. MÉTODOS: Amostras de onze municípios do Estado Paraná, Brasil, foram cedidas pelo Laboratório Central do Paraná e consistiam em isolados de cultura de células da linhagem C6/36 (Aedes albopictus), positivos para técnica de imunofluorescência indireta. O Ribonucleic acid (RNA) dessas amostras foi extraído, seguido da transcrição reversa, reação em cadeia da polimerase (PCR) e nested PCR. RESULTADOS: Co-infecção por DENV-1 e 2 (virus da dengue 1 e 2) foi observada em quatro pacientes, através da técnica Reverse transcriptase-polymerase chain reaction (RT-PCR). Para o DENV-1 a porcentagem de similaridade variou de 95 a 100% comparando com cepas do Genbank. Para o DENV-2 a porcentagem de similaridade variou de 98 a 100%. De acordo com o cladograma gerado, todas as cepas deste estudo se agruparam no genótipo V para DENV-1. Para o DENV-2 foi encontrada a cepa referente ao genótipo asiático/americano. CONCLUSÕES: O monitoramento das cepas circulantes torna-se uma ferramenta importante na detecção da migração dos subtipos do vírus da dengue envolvidos em epidemias.

Epidemiological characteristics of pulmonary pneumocystosis and concurrent infections in pigs in Jeju Island, Korea

Epidemiological characteristics of swine pulmonary Pneumocystis (P.) carinii and concurrent infections were surveyed on Jeju Island, Korea, within a designated period in 172 pigs submitted from 54 farms to the Department of Veterinary Medicine, Jeju National University. The submitted cases were evaluated by histopathology, immunohistochemistry, PCR/RT-PCR, and bacteriology. P. carinii infection was confirmed in 39 (22.7%) of the 172 pigs. Histopathologically, the lungs had moderate to severe lymphohistioctyic interstitial pneumonia with variable numbers of fungal organisms within lesions. Furthermore, porcine reproductive and respiratory syndrome virus (PRRSV) and porcine circovirus type 2 (PCV-2) co-infection was a common phenomenon (12.8%, 20.5%, and 48.7% were positive for PRRS, PCV-2, or both, respectively, as determined by PCR/RT-PCR). Infection was much more concentrated during winter (December to March) and 53.8% of the infected pigs were 7- to 8-weeks old. In addition, three pigs showed co-infection with bacteria such as Pasteurella multocida and Streptococcus suis. The results of the present study suggest that the secondary P. carinii infection is common following primary viral infection in swine in Korea. They further suggest that co-infection of P. carinii might be enhanced by the virulence of primary pathogens or might have synergistic effects in the pigs with chronic wasting diseases.