Dengue and concurrent urinary tract infection

Abstract

To the editor, Sir, dengue is an important tropical borne infection that can manifest the hemorrhagic manifestation[1]–[5]. However, the concurrent infection to dengue can be expected and becomes an interesting condition in tropical medicine. Here, the authors present an interesting accidental finding of a case of dengue with concurrent urinary tract infection. The case is a 61 years old already menopause female patient presenting to the physician with the complaint of dysuria for about 2 weeks. She was a known diabetic case. At this visit, the physician in charge performed urinalysis and detected white blood cell >100/HPF with red blood cell 1-2/HPF. This case was diagnosed to have urinary tract infection and prescribed for oral cephalexin (1 g/d) treatment. However, one day later, she revisited to the physician complaining of very high fever (39 °C) and more pain during urination. Repeated urinalysis was done at this time and revealed white blood cell 20-30/HPF with red blood cell 10-20/HPF. At that stage, the physician in charge suspected for other additional cause of fever adding to the already diagnosed UTI. The physician in charge additional performed complete blood count and the important finding is platelet equal to 10 000/mm3. The dengue IgM test was done and show positive result. This case was treated by fluid replacement therapy and full recovery can be detected. This concurrent infection is not a common and can be misdiagnosed if the physician in charge did not follow up urinalysis and performed additional laboratory investigation. There are few reports on dengue and concurrent urinary infection. This condition can be late diagnosed and shock can be seen[6]. In a recent report from Singapore, this condition can be seen in 1 from 400 dengue index cases[7]. Indeed, both dengue and urinary tract infections are common problems in the tropical countries. Both conditions are considered important problems frequently seen in ones who live or travel to the tropical region[8]. The authors hereby would like to suggest that a) in dengue case, adding urinalysis to laboratory profile can be useful for finding of concurrent UTI and b) the practitioner has to concern on the possible concurrent infection in case firstly present as dengue or as UTI.