A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever.

Publisher: Springer Country of Publication: Germany NLM ID: 8804297 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1435-4373 (Electronic) Linking ISSN: 09349723 NLM ISO Abbreviation: Eur J Clin Microbiol Infect Dis Subsets: MEDLINE

Publication: Berlin : Springer
Original Publication: [Wiesbaden, Federal Republic of Germany] : Vieweg, [c1988-

Coinfection/*epidemiology ; Dengue/*epidemiology ; Fever of Unknown Origin/*epidemiology ; Malaria/*epidemiology ; Scrub Typhus/*epidemiology; Adolescent ; Adult ; Aged ; Dengue/complications ; Dengue/pathology ; Female ; Fever of Unknown Origin/etiology ; Hospitals ; Humans ; India/epidemiology ; Malaria/complications ; Malaria/pathology ; Male ; Middle Aged ; Retrospective Studies ; Scrub Typhus/complications ; Scrub Typhus/pathology ; Young Adult

Positive serology for dengue and/or scrub typhus infection with/without positive malarial smear (designated as mixed or co-infection) is being increasingly observed during epidemics of acute undifferentiated febrile illnesses (AUFIs). We planned to study the clinical and biochemical spectrum of co-infections with Plasmodium sp., dengue virus and scrub typhus and compare these with mono-infection by the same organisms. During the period from December 2012 to December 2013, all cases presenting with AUFIs to a single medical unit of a referral centre in Garhwal region of the north Indian state of Uttarakhand were retrospectively selected and categorised aetiologically as co-infections, malaria, dengue or scrub typhus. The groups thus created were compared in terms of demographic, clinical, biochemical and outcome parameters. The co-infection group (n = 49) was associated with milder clinical manifestations, fewer, milder and non-progressive organ dysfunction, and lesser need for intensive care, mechanical ventilation and dialysis as compared to mono-infections. When co-infections were sub-grouped and compared with the relevant mono-infections, there were differences in certain haematological and biochemical parameters; however, this difference did not translate into differential outcomes. Scrub typhus mono-infection was associated with severe disease in terms of both morbidity and mortality. Malaria, dengue and scrub typhus should be routinely tested in all patients with AUFIs. Co-infections, whether true or due to serological cross-reactivity, appear to be a separate entity so far as presentation and morbidity is concerned. Further insight is needed into the mechanism and identification of the protective infection.

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Date Created: 20160208 Date Completed: 20161213 Latest Revision: 20181113

20221213

10.1007/s10096-016-2590-3

26851948