Case series of fatal Leptospira spp./dengue virus co-infections-Puerto Rico, 2010-2012.

Abstract

Co-infection with pathogens that cause acute febrile illness creates a diagnostic challenge as a result of overlapping clinical manifestations. Here, we describe four fatal cases of Leptospira species/dengue virus co-infection in Puerto Rico. Although all patients sought care early, antibiotic administration was delayed for most. Steroids were administered to all patients, in most cases before antibiotics. These cases show the need for clinicians evaluating patients in or recently returned from the tropics with acute febrile illness to consider both dengue and leptospirosis. Furthermore, they illustrate the need for nucleic acid- or antigen-based rapid diagnostic tests to enable timely patient diagnosis and management. In particular, antibiotic therapy should be initiated early for patients with suspected leptospirosis, and steroids should not be administered to patients with suspected dengue.

• Authors: Nicole M Pérez Rodríguez, Renee Galloway, Dianna M Blau, Rita Traxler, Julu Bhatnagar, Sherif R Zaki, Aidsa Rivera, Jose V Torres, David Noyd, Xavier E Santiago-Albizu, Brenda Rivera García, Kay M Tomashek, William A Bower, Tyler M Sharp
• Journal: The American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 91 Issue 4 Pg. 760-5 (Oct 2014) ISSN: 1476-1645 [Electronic] United States
• PMID: 25092820 (Publication Type: Case Reports, Journal Article)
• Copyright: © The American Society of Tropical Medicine and Hygiene.

Chemical References

• Anti-Bacterial Agents
• Steroids

Topics

• Adult
• Aged
• Anti-Bacterial Agents (administration & dosage)
• Coinfection
• Dengue (diagnosis, drug therapy, virology)
• Dengue Virus (isolation & purification)
• Fatal Outcome
• Humans
• Leptospira (isolation & purification)
• Leptospirosis (diagnosis, drug therapy, microbiology)
• Male
• Middle Aged
• Puerto Rico
• Steroids (administration & dosage)
• Young Adult