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Bacterial coinfections in dengue virus disease: what we know and what is still obscure about an emerging concern

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Abstract

Purpose

Dengue virus is the most frequent arthropod-borne viral infection worldwide. Simultaneously to the growth of its incidence, cases of bacterial coinfection in dengue have been increasingly reported. The clinical course of dual infections may worsen for reciprocal interactions and delays in the diagnosis, so that clinicians should be aware of this eventuality. Therefore, we reviewed literature to provide an overview of the epidemiological, clinical, and physiopathological issues related to bacterial coinfections and bacteremia in dengue.

Methods

Clinical studies and case reports regarding bacteremia and bacterial coinfections in dengue and the interactions between the pathogens published on PubMed were reviewed.

Results

We found 26 case reports, only 3 studies on concurrent bacteremia and 12 studies reporting data on bacterial coinfections in dengue. According to the three available studies, the 0.18–7 % of dengue infections are accompanied by concurrent bacteremia, while the 14.3–44.4 % of dengue-related deaths seem associated to bacterial coinfections. Comorbidities, advanced age, and more severe dengue manifestations could be risk factors for dual infections. A longer duration of fever and alterations in laboratory parameters such as procalcitonin, hyponatremia, leukocyte count, and renal function tests can raise the suspicion.

Conclusions

Despite the real burden and consequences of this emerging concern is still not computable accurately due to the lack of a significant number of studies on large cohorts, clinicians need a greater awareness about it to early recognize warning signs, to properly use available diagnostic tools and to readily start antibiotic treatment able to prevent worsening in mortality and morbidity.

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Acknowledgments

We are grateful to Irene Molin for the figure and to Ivano Dal Conte for his advices.

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Authors and Affiliations

  1. Department of Medical Sciences, Universitary Clinic of Infectious and Tropical Diseases, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy

    Mattia Trunfio

  2. Department of Health Sciences, Universitary Clinic of Infectious and Tropical Diseases, San Paolo Hospital, University of Milano, Via A. di Rudinì 8, 20142, Milan, Italy

    Alessia Savoldi, Ottavia Viganò & Antonella d’Arminio Monforte

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  1. Mattia Trunfio
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  2. Alessia Savoldi
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Correspondence to Mattia Trunfio.

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Trunfio, M., Savoldi, A., Viganò, O. et al. Bacterial coinfections in dengue virus disease: what we know and what is still obscure about an emerging concern. Infection 45, 1–10 (2017). https://doi.org/10.1007/s15010-016-0927-6

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