Dengue Co-infection Research Articles

Newest “co-members” of the 1000s club: A case of severe transaminitis secondary to Epstein-Barr and dengue virus co-infection in a returning traveler

Background: Timely identification of the etiology of transaminitis is critical in informing subsequent management as strategies can vary from supportive care to urgent transplant assessment. This is especially important in returning travelers as there may be multiple causes of injury that need to be addressed. Case report: We present a case of severe transaminitis secondary to non-hepatitis viral co-infections. A 28-year-old south Asian male returning traveler presented with an acute liver injury (aspartate aminotransferase/alanine aminotransaminase levels of >4000 IU/l) and marked jaundice. A thorough and expanded work-up of acute hepatitis was negative aside from positive mononucleosis spot testing and positive dengue fever serologies. This atypical presentation of mononucleosis and dengue fever was managed conservatively, and the patient was discharged with outpatient follow-up after an eight-day admission. Conclusions: Usually, non-hepatitis viruses typically do not present with severe transaminitis or hyperbilirubinemia. These viruses, such as infectious mononucleosis and dengue fever, may work synergistically to cause an elevated inflammatory response, resulting in severe transaminitis in returning travelers. In the absence of a classic clinical presentation, clinicians should be aware of co-infections in returning travelers and test for them based on a thorough history and physical examination.

Molecular Detection of Malaria Co-Infections with Some Arboviruses in Pregnant Women Attending Ante-Natal in Hospitals within Bauchi State, Nigeria

Malaria and arboviruses are public health menaces, causing major morbidity in developing countries and are more severe in pregnancy leading to adverse effects which can lead to fetal and maternal death, hence, this study determined the prevalence of dengue, zika and malaria infections among pregnant women attending antenatal clinics in some hospitals within Bauchi Local Government Area, Bauchi State, Nigeria. One hundred and seventy-seven blood samples of pregnant women were collected and screened for malaria using the Rapid Diagnostic test kits, while the diagnosis for dengue and zika infections was done using real time Polymerase Chain Reaction (RT-qPCR). From the blood samples tested, 50 (28.25%) were positive for malaria, 1 (2.00%) sample was positive for dengue and dengue-malaria co-infection, however, no sample was positive for zika virus (0%). Malaria was recorded across all the age groups with a high statistical significance, dengue was prevalent between age 15-25years (2.35%) and 26-35years (1.35%) while dengue-malaria co-infection was only seen in age group 15-25years (1.18%). Pregnant women with fever and the trimesters were significantly associated with the prevalence of malaria (P<0.05 respectively); Educational qualification and occupation were significantly associated with dengue infections (P<0.05 for both) as well as dengue-malaria co-infection (P=0.05 for both), whereas history of miscarriages was only statistically associated with prevalence of dengue infections (P=0.02204). Despite the low prevalence of dengue virus among pregnant women in this study, the result of this study gives an overview of dengue, zika and malaria in Bauchi, thereby providing the first baseline data.

Dengue and malaria coinfection in a traveling patient: Case study

Introduction: Dengue and malaria are two prevalent diseases in the tropics, transmitted by vectors, and cause different morbidity and fatality rates. However, coinfection of dengue and malaria is relatively rare but clinically significant, since both diseases can have severe manifestations and their coexistence complicate diagnosis and treatment. Clinical Case: The clinical case of a male patient, 32 years old, resident in Angola, who entered Ecuador twenty-one days prior to the onset of symptoms, with no history, was hospitalized for unquantified temperature rise, myalgia, arthralgia and fatigue. His clinical picture is exacerbated with abdominal pain in the right upper quadrant and generalized rash, BP: 105/58 mmHg, HR: 108 bpm, RR: 18 rpm, pulse oximetry 98%, T°: 38°C, dry oral mucosa, expansibility of the decreased chest, dysrhythmic heart, no murmurs, painful abdomen, absent fluid sounds, extremities without edema. The rapid antigen test performed was positive for Plasmodium falciparum, thick smear positive for Plasmodium falciparum. Discussion: The simultaneous treatment of malaria and dengue required careful monitoring of warning signs and possible complications; collaboration between health professionals from Ecuador and Angola was necessary for the successful management and handling of the patient.Conclusions: Documentation of such cases should influence health policies and the planning of preventive strategies, such as vaccination, vector control, and preventive education of travelers before visiting endemic areas.

Immunopathogenesis of dengue virus and Salmonella typhi coinfection

Typhoid, malaria, leptospirosis, dengue virus (DENV), and other arboviruses are endemic in Indonesia. Therefore, it is more likely that DENV and other infectious diseases could be coinfected. More severe symptoms, delayed identification, and ineffective treatment of the illness can all result from Salmonella typhi coinfection. To serve as a principle for clinicians’ considerations while diagnosing and prescribing, we aim to examine the immunopathogenesis of dengue associated with Salmonella typhi coinfection. Dengue virus has the potential to increase both susceptibility and incidence of this coinfection, leading to dengue haemorrhagic fever (DHF) with more severe clinical symptoms. This is explained by regulating impact of coinfection in the presence of gram-negative membrane endotoxin, DENV replication, and lipopolysaccharide (LPS). If Salmonella typhi coinfection is not treated promptly, both dengue and Salmonella typhi can affect several organs and result in significant morbidity and death. Dengue and typhoid immunopathogenesis coinfection are unclear. When dengue monoinfection compared with Salmonella dengue dual infections are related to higher fatality and morbidity rates.

Dengue and leptospirosis coinfection: a case series

BackgroundBoth dengue and Leptospira infections are endemic to tropical and subtropical regions, with their prevalence increasing in recent decades. Coinfection with these pathogens presents significant diagnostic challenges for clinicians due to overlapping clinical manifestations and laboratory findings. This case report aims to elucidate two clinical scenarios where the coinfection of dengue and leptospirosis complicates the disease course, creating a diagnostic conundrum.Case presentationWe present the clinical scenarios of two Bangladeshi males, aged 25 and 35 years, who were admitted to our hospital with acute febrile illness. The first patient exhibited hepatic and renal involvement, while the second presented with symptoms initially suggestive of meningoencephalitis. Both cases were initially managed under the presumption of dengue infection based on positive serology. However, further evaluation revealed coinfection with Leptospira, complicating the disease course. Both patients received appropriate treatment for dengue and antibacterial therapy for leptospirosis, ultimately resulting in their recovery.ConclusionThese case scenarios underscore the critical importance for clinicians in regions where dengue and Leptospira are endemic to consider both diseases when evaluating patients presenting with acute febrile illness.

Clinical Picture and Risk Factors for Severity of SARS-CoV-2 and Dengue Coinfection in Children: Experience From a Tertiary Hospital in Vietnam.

Introduction Dengue is an infectious disease that is a burden in Asia-Pacific and Latin America. The COVID-19 pandemic in dengue-endemic areas has caused a "double burden" because of the possibility of coinfection, especially in children who are vulnerable to both COVID-19 and dengue. This study aimed to describe the characteristics and identify risk factors for the severity of the coinfection in Vietnamese children. Methods This was a retrospective cohort study, undertaken at Children's Hospital 1 (Ho Chi Minh City, Vietnam) during the fourth wave of the COVID-19 pandemic. All children under 16 years old who were admitted to the hospital from April 27, 2021 to June 30, 2022, and diagnosed with SARS-CoV-2 and dengue coinfection were included. Results From April 2021 to June 2022, a total of 31 patients with the coinfection were included, with 19 of them being male (61.3%). The median age was 10.8 years old (IQR, 5.1-14.1). Fourteen children (45.2%) had preexisting comorbidities, with the most common comorbidity being overweight/obesity (ten children). Nearly two-thirds of the children were diagnosed with dengue without/with warning signs (61.3%) and were classified as having mild COVID-19 (83.9%). The most frequently observed clinical characteristics were fever (n=29, 93.6%), followed by abdominal pain, vomiting, and petechiae. All patients had high serum ferritin, and 83.9% presented with thrombocytopenia. None of thecases died. Overweight/obesity, abdominal pain, and petechiae were factors independently associated with severe disease. Conclusion Most of the children had mild COVID-19 and disease progression similar to patients with dengue alone. However, some children may have severe COVID-19 and dengue coinfection. Obesity, abdominal pain, and petechiae were identified as independent risk factors for disease severity in pediatric cases. Further studies with multicenters and a larger sample size are needed to assess the coinfection more thoroughly.

Dynamical analysis of SARS-CoV-2-Dengue co-infection mathematical model with optimum control and sensitivity analyses

This study develops an epidemic model to analyze the dynamics of SARS-CoV-2 and dengue coinfection in a population. The population is divided into sixteen compartments for humans and three for vectors. The model’s validity is ensured by maintaining bounded and non-negative solutions. The Basic Reproduction Number (BRN) is calculated for each sub-model to assess stability at equilibrium points. Sensitivity analysis identifies key parameters influencing the model. The complete coinfection model is analyzed to identify equilibrium points and evaluate stability conditions. The reciprocal influence of SARS-CoV-2 and dengue diseases is examined. An optimal control problem is formulated, incorporating six strategies: COVID-19 protection, mosquito bite prevention, treatment for COVID-19 and dengue, mosquito control, and coinfection treatment. Numerical simulations validate the effectiveness of these control strategies for the coinfection model and its sub-models.

Dengue Reinfection and Co-infection: A Study of Incidence and Outcomes in Adults Admitted to a Tertiary Care Hospital, Karachi, Pakistan

Aim: To determine the occurrence of re-infection and co-infection with dengue among the adult population in Karachi, Pakistan. In addition, to determine the frequency of various medical complications among dengue patients with or without co-infection and reinfection. And to identify possible risk factors associated with dengue reinfection. Study Design: Retrospective cross-sectional study. Place and Duration of Study: Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan, between January 2022 and August 2022. Methodology: A total of 500 adult patients aged 18 years or above; admitted with a confirmed diagnosis of dengue were included in the study. Information was collected regarding clinical and demographic data using structured questionnaire. Data was analyzed using SPSS version 25. Results: The current study reported an incidence of 3.8% for dengue re-infection and an incidence of 19% for co-infection among adult dengue patients. The most common clinical symptoms were fever, nausea, vomiting, and abdominal pain while bleeding, acute kidney injury, and nosocomial infection were the most common complications with a proportion of 10.6% (n=53), 7.8% (n=39) and 4.2% (n=21). The study could not find any statistical association between the socio-demographic factors and disease-related characteristics. Conclusion: This study determines a low incidence proportion of dengue re-infection and co-infection among adult patients admitted with a confirmed diagnosis of dengue infection at a private tertiary care hospital in Karachi. Bleeding, nosocomial infection, and acute kidney injury were identified as the most frequent medical complications among hospitalized dengue patients. The study did not show any statistically significant risk factors associated with dengue re-infection. Large scale multi-center studies are warranted with sufficient sample size and objective assessment methods to determine the incidence of dengue re-infection and co-infection as well as for the identification of risk factors associated with dengue re-infection among the adult population of Pakistan.

CLINICAL AND LABORATORY PROFILE OF ADMITTED PATIENTS PRESENTING WITH FEBRILE ILLNESS DUE TO DENGUE AND SCRUB TYPHUS COINFECTION FROM A TERTIARY CARE HOSPITAL IN SOUTH RAJASTHAN, INDIA

Objective: The present study aims at describing the clinical features, laboratory diagnosis, and complications in patients presenting with febrile illness due to scrub typhus and dengue coinfection from Southern Rajasthan, India. Method: This present prospective, observational, and hospital-based study conducted in the Department of Microbiology of AIMS & RC, Rajsamand, located in Southern Rajasthan, from January 2021 to December 2021. Scrub typhus was diagnosed in the microbiology laboratory by performing SD Bioline, one-step scrub typhus for the detection of IgM antibody, and dengue fever using J.mitra and Co. Pvt. Ltd., rapid card test for the detection of NS1 antigen and IgM antibody. Result: Out of 500 patients suspected of AUFI, 25 (5%) patients diagnosed of having dengue and scrub typhus coinfection. Fever was present in all 25 (100%) patients and 13 (52%) of patients had arthralgia, nausea, and vomiting. The most common sign noticed in our study was pallor and icterus in 10 (40%) patients each followed by shock/hypotension in 8 (32%) and hepatosplenomegaly in 5 (20%). The most predominant laboratory finding was thrombocytopenia (<1.0 × 106/cumm) in 23 (92%) patients, while elevated bilirubin (>2 mg/dl) in 22 (88%) and elevated transaminase and prolonged aPTT in 21 (84%) patients each. The majority of patients 23 (92%) had hepatic dysfunction, i.e., in followed by multi-organ dysfunction (MODS) in 15 (60%). Conclusion: In developing countries like India, particularly in tropical areas, dengue, and scrub typhus coinfection is under-recognized entity. Additional investigation should be carried out in cases of AUFI patients with features such as hypotension, leukocytosis, early drop in platelet counts, and hypoalbuminemia.

High prevalence of dengue, Zika, and chikungunya viruses in blood donors during a dengue outbreak and an endemic period in Colombia.

Arboviruses pose a challenge in ensuring the supply of pathogen-free blood components because they are not routinely screened in blood banks, and blood components from infected asymptomatic donors could be transfused. This study aimed to detect and characterize arboviral infections in Colombian blood donors. In a cross-sectional study, the prevalence of dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) viruses and co-infections of blood donors were compared between an epidemic period (November 2019-February 2020, n = 462) and an endemic period (November 2021-August 2022, n = 1,119). Viral RNA from each donor serum was purified, and the viruses were detected using a previously standardized multiplex hemi-nested RT-PCR protocol. Subsequently, donors who tested positive were surveyed 15 days after the detection of the virus to identify clinical characteristics related to the arboviral infection. The prevalences of each virus were presented as percentages and compared between epidemic and endemic periods. Significantly higher prevalences were found in the epidemic period compared with the endemic period for DENV (14.5 vs. 1.9%), ZIKV (7.8 vs. 0.3%), CHIKV (8 vs. 3.3%), and co-infections (4.3 vs. 0.2%). The survey response rate of positive donors in the two periods was 83/175 (47%). In total, 57% of the donors surveyed were asymptomatic. Symptomatic donors most frequently reported headache (31%), malaise (13%), arthralgia (10%), and fever/chills (8%). The prevalence observed in epidemic and endemic periods was higher than that reported in other studies in the Americas. The high proportion of asymptomatic cases found, in addition to the mild and nonspecific manifestations among the symptomatic, may limit the effectiveness of the donor selection criteria used to mitigate the risk of transfusion-transmitted arboviruses.

Dengue fever coinfection in COVID-19 era: A public health concern.

Dengue and SARS-CoV-2 coinfection is commonly encountered and constantly reported in particularly the dengue-endemic regions thus posing a co-epidemic threat. Coinfection is also significantly associated with morbidity and mortality. Comorbidity risk during a coinfection is of a greater concern. Although the pathophysiologies of the two infections vary, their identical clinical symptoms during coinfection result in diagnostic and therapeutic complexities. A literature search for the current relevant reports was carried out. The searched databases were Scopus, PubMed, Google Scholar and the Web of Science, with health agencies like the WHO. Based on the selection criteria, the most recent and pertinent reports published in English language were included for the ease of understanding, deciphering and analysing the secondary data. A delay in proper diagnosis of coinfection could result in serious complications with poor patient outcome. Whether it is a standalone dengue or COVID-19 infection or a coinfection, specific biomarkers may be utilized for its foolproof diagnosis. This article highlights the various diagnostic techniques and immune responses from the perspective of prompt and appropriate public health management for patients suffering from COVID-19 and dengue viral coinfections, both being independently or collectively capable of damaging a human body. As coinfection poses significantly large burden on an already-fragile healthcare facility, constant monitoring of a coinfected patient is needed for prompt and suitable therapeutics. Also, to maintain high vigilance and invoke appropriate preventive measures particularly in dengue endemic regions, the government, healthcare authority and the general public need to collaborate and cooperate.

Case Report: Managing the Coinfection of Cerebral Malaria and Dengue in the Intensive Care Unit

Background: Dengue and malaria are the two most common arthropod-borne illnesses, but cases of multiple infections are extremely uncommon. The mortality rate for individuals with dengue and malaria was higher than the death rate for those with malaria alone.Case: An intubated 53-year-old male was referred from a class B hospital because of severe malaria with suspected cerebral malaria, dengue fever (day-11), septic shock and acute kidney injury. His initial laboratory investigation showed increasing pattern of WBC, thrombocyte, anemia, peripheral blood smear normochromic normocytic erythrocyte, poikilocytosis (ovalocytes (+), teardrop cells (+)), normoblasts (+), presence of Plasmodium malariae trophozoite and schizont stage parasites, positive result of IgM and IgG anti dengue, increased liver function test, increased BUN and creatinine serum levels, hyperbilirubinemia, hypoalbuminemia, and normal result of blood gas analysis. On the sixth day of ICU admission, the patient gradually regained consciousness with appropriate responsiveness and showed clinical improvement. The patient was discharged after one month of hospital care with the last peripheral blood smear showing no parasites detected.Discussion: Mono-infection with malaria and dengue, two mosquito-borne diseases endemic to tropical and subtropical regions, often carries a high risk of fatality. The risk becomes even more pronounced when co-infection occurs. The early diagnosis and management in the ICU are crucial for cases of coinfection involving cerebral malaria and dengue. The primary focus is on both definitive and supportive therapies.Conclusion: The prognosis for coinfection of cerebral malaria and dengue is generally poor, but in this case, the patient showed improvement and was able to be discharged without any sequelae.

Frequency of Dengue and Malaria Co-Infection in Patients Admitted in Jinnah Hospital, Lahore

Prevalence of malaria and dengue infection coexistence is increasing during endemic periods although causing quite similar symptoms and signs, the treatment of these two illnesses is different. Any suspicion of malaria in disease-endemic areas must be excluded with microscopy and/or rapid antigen test. Objective: To find out the incidence of co-infection of dengue and malaria based on clinical and hematological parameters in patients presenting with acute febrile illness. Methods: This cross-sectional study was done in the Medicine Unit of Jinnah hospital, Lahore from October - December 2022. 140 diagnosed as dengue fever by Non-Structural Protein 1 (NS1) and IgM were included in the study. All the cases were subject to a thorough medical examination i.e. complete battery summary of temperature together with the serology of Dengue, X-ray of the chest, abdominal ultrasound scan, renal function test (RFT), liver function test (LFT), malarial parasite slide, complete blood count with peripheral smear etc. Accordingly, the treatment was given to them with follow-up medical evaluation including detailed investigations. Data were entered and analyzed in SPSS version. 27.0 and presented as frequency and percentages. Chi square test was used to assess statistical significance with P < .05. Results: Mean age of respondent was 35.5 + 15.6 years. Co-infection rate with malaria and severe disease along with prolong duration fever and persistent thrombocytopenia among subjects was15.0%. Conclusions: Majority of co infected individuals were having severe disease, with subsequent development of disseminated intravascular coagulation and sepsis, responding well to anti-malarial treatments

Global stability and Sensitivity Analysis of Malaria, Dengue and Typhoid Triple Infection

This study investigates the global stability of the endemic equilibrium point of triple co-infection of malaria, dengue, and typhoid. By using an appropriate Lyapunov function, the results show that the model is globally asymptotically stable. This implies that the diseases can be eradicated or kept at low levels, regardless of the population. Sensitivity analysis was also conducted to identify the most sensitive parameter. The results indicate that strategies to reduce malaria and dengue fever vectors should be prioritized to curb the spread of the diseases. Additionally, minimizing exposure to contaminated water and food, as well as reducing the discharge of typhoid bacteria into the environment, can help to reduce or curb the spread of typhoid in the environment.

A Narrative Review on Dengue and COVID-19 Co-infection: A Deadly Duo

Abstract The ongoing COVID-19 pandemic in dengue-endemic countries falls as a huge burden on healthcare infrastructure. Above everything, similar signs and symptoms of diseases caused by the two viruses make diagnosis and treatment more difficult. For this literature review, published articles from January 2020 to March 2023 available in the databases ‘PubMed’, ‘Google Scholar’ and ‘Embase’ have been explored to look at the similarities and differences between dengue and SARS-CoV-2 virus through the lens of genomics, epidemiology, clinical presentation and outcome of patients. The objectives of this study were to draw conclusions about the proposed pathophysiology of the viruses in case of a co-infection and to narrate evidence on outcome associated with the co-infection. Co-infection with dengue and COVID-19 virus can lead to moderate-to-severe morbid conditions; even the outcome could be fatal due to shock, multi-organ failure and stroke.

Dengue and Malaria Co-infection in a Young Adult with Atypical Feature

As an endemic zone, malaria and dengue coinfection can be expected in Bangladesh, although there have not been enough case reports of such coinfection. We describe a previously healthy 22-year-old male from Dhaka, with a history of travelling to Coxs-Bazar 3 weeks ago, presented with fever with chills and rigors, generalized weakness and cough for 2 weeks. Clinical examination showed tachycardia, hypotension, subconjunctival haemorrhage and positive tourniquet test. Lab reports showed NS1-Ag positive, thrombocytopenia, progressive anaemia, mild hyperbilirubinemia. He was treated initially for dengue haemorrhagic fever. His laboratory parameters started improving; however, he had persistent fever with chills and rigors daily and persistent coughing. Peripheral smear for Malaria showed schizonts and trophozoites of Plasmodium falciparum and ICT for malaria was positive. He recovered following treatment with IV fluids and oral artesunate. The presence of fever even in a critical phase of dengue, the typical rise of temperature daily, progressive anaemia, mild jaundice and specific travelling history gave a clue of coinfection with Malaria. On follow-up, after 2 weeks, he had no symptoms, and all the laboratory parameters were normal. challenge was the atypical features like dry cough and exertional dyspnoea. The timely diagnosis and appropriate treatment were crucial for prognosis of this patient. Bangladesh J Medicine 2024; 35(1): 38-41

Determinants and prevalence of symptomatic dengue fever among adults in the Central Region of Burkina Faso: a hospital-based cross-sectional study

BackgroundDengue fever (DF) is a significant public health concern in Burkina Faso, particularly in the Central Region, previously endemic for malaria. However, limited research has focused on dengue prevalence and associated factors among adult febrile patients in this region. This study aimed to estimate the prevalence of symptomatic dengue fever among adults and identify the sociodemographic and clinical determinants of the disease.MethodsA seroepidemiological cross-sectional study was conducted in the Central Region of Burkina Faso, through a three-stage sampling. Five health facilities, one from each of the region five districts, were purposively selected. Febrile patients aged 16 and older, suspected of having dengue, were included in the study, after consenting. Bivariate analyses and multivariate binary logistic regression were done at a 5% confidence level.ResultsA total of 637 patients between the ages of 16 and 90 years were included. Most of the participants were females (58.71%). Most dengue cases resided in Arrondissement 4 (59.62%), or were present in the Arrondissement 4 at daytime during the previous days (51.92%). 52.90% of the participants knew of dengue. Dengue prevalence was estimated at 8.16% (95% CI: 6.16%-10.57%). The most frequent markers for dengue were immunoglobulins M detected in 4.40% (2.94%-6.29%), followed by Antigen NS1 at 4.24% (95% CI: 2.81%-6.11%). The Antigen NS1 marker was associated with myalgia (p = 0.024), vomiting (p < 0.001), hemorrhagic manifestations (p = 0.001), and anorexia (p < 0.001). Staying at Arrondissement 4 (vs staying at Saaba) during daytime (aOR = 2.36 95% CI: 1.03–5.45; p = 0.044) significantly increased the odds of dengue. Dengue cases were about 3 times more likely to have vomited (aOR = 2.99 95% CI: 1.58–5.64; p = 0.001). Participants knowing of dengue (aOR = 0.53 95% CI: 0.29–0.98; p = 0.042) and those coinfected with malaria (aOR = 0.28 95% CI: 0.14–0.57; p < 0.001) instead had reduced odds of dengue.ConclusionThe study revealed a relatively high prevalence of symptomatic dengue fever among adults in the Central Region of Burkina Faso in 2022. These findings emphasize the need for continuous surveillance and targeted control measures. The low coinfection of dengue and malaria warrants further investigation.

Seroprevalence and Co-infections of Different Infectious Aetiologies in Blood Culture Negative Febrile Patients Seeking Healthcare at a University Hospital in Northern India: A Cross-sectional Study

Introduction: The burden of acute febrile illness remains underestimated in many low- and middle-income countries. The rationale of this study revolves around the gaps in diagnostics for acute febrile illnesses in these regions. Aim: To highlight the seroprevalence and co-infections of different infectious aetiologies in blood culture negative febrile patients. Materials and Methods: This cross-sectional study was conducted at Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India from October 2021 to July 2022, involving 153 serum samples from patients presenting with fever for less than two weeks duration during outpatient and emergency visits. The blood culture negative samples were further tested for other aetiologies such as Leptospirosis, Dengue NS1 antigen, Dengue IgM antibody, Chikungunya, Scrub typhus IgM, and Widal, respectively. Convalescent sera were also tested for all positive Widal results. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) statistical software (IBM SPSS version 26.0, Armonk, N.Y.). Results: Out of the 153 patients enrolled, 120 patients were tested for a panel of serological tests. The majority 52 (43.3%) were aged between 21 and 40 years. Fifty-five patients (45.8%) exhibited positivity, among which Scrub typhus was the most common aetiology with 21 (17.5%) case, followed by Leptospirosis 19 (15.8%), Dengue 10 (8.3%), Chikungunya 3 (2.5%), and Enteric fever 2 (1.7%), with no cases of malaria reported. Overall, co-infections reported in present study included 7 (5.8%) cases, of which scrub typhus and Leptospirosis were the most prevalent in 5 (4.16%) cases. Two patients (1.6%) presented with a co-infection of dengue and chikungunya. Conclusion: The diverse aetiologies causing acute febrile illness necessitate a syndrome-based disease surveillance approach, accompanied by strong clinical acumen, for the betterment of patient outcomes.

Dynamic analysis of a coinfection model of dengue and asymptomatic and symptomatic COVID-19

The purpose of this paper is to investigate the transmission dynamics of COVID-19 with Dengue coinfection using a mathematical model. The human population was divided into six compartments, while the mosquito population was divided into two sections. The model considers that COVID-19 infection might be symptomatic or asymptomatic. First, we analyzed the dengue infection model. The basic reproduction number of the COVID-19 infection system and the Dengue infection system are used to forecast illness mitigation and persistence (denoted by ℛ0C and ℛ0D respectively). The qualitative examination of the sub-systems indicated that the disease-free equilibrium (DFE) is locally asymptotically stable provided the corresponding reproduction numbers are less than one. The coinfection model is then analyzed to yield the basic reproduction number, designated by ℛ0. The DFE and stability of the coinfection model are dependent on ℛ0 = max {ℛ0D, ℛ0C}. The numerical simulation of the coinfection model showed the existence of the endemic equilibrium of the coinfection model. Furthermore, we studied the dynamic solutions of the coinfection model by establishing the equilibrium points and evaluated the stability requirements.

Emergence of SARS-CoV-2 Variants Are Induced by Coinfections With Dengue.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in late 2019 has accumulated a series of point mutations and evolved into several variants of concern (VOCs), some of which are more transmissible and potentially more severe than the original strain. The most notable VOCs are Alpha, Beta, Gamma, Delta, and Omicron, which have spread to various parts of the world. This study conducted surveillance in Jashore, Bangladesh to identify the prevalence of SARS-CoV-2 coinfected with dengue virus and their genomic effect on the emergence of VOCs. A hospital-based COVID-19 surveillance from June to August, 2021 identified 9 453 positive patients in the surveillance area. The study enrolled 572 randomly selected COVID-19-positive patients, of which 11 (2%) had dengue viral coinfection. Whole genome sequences of SARS-CoV-2 were analyzed and compared between coinfection positive and negative group. In addition, we extracted 185 genome sequences from GISAID to investigate the cross-correlation function between SARS-CoV-2 mutations and VOC; multiple ARIMAX(p,d,q) models were developed to estimate the average number of amino acid (aa) substitution among different SARS-CoV-2 VOCs. The results of the study showed that the coinfection group had an average of 30.6 (±1.7) aa substitutions in SARS-CoV-2, whereas the dengue-negative COVID-19 group had that average of 25.6 (±1.8; P < .01). The coinfection group showed a significant difference of aa substitutions in open reading frame (ORF) and N-protein when compared to dengue-negative group (P = .03). Our ARIMAX models estimated that the emergence of SARS-CoV-2 variants Delta required additional 9 to 12 aa substitutions than Alpha, Beta, or Gamma variant. The emergence of Omicron accumulated additional 19 (95% confidence interval [CI]: 15.74, 21.95) aa substitution than Delta. Increased number of point mutations in SARS-CoV-2 genome identified from coinfected cases could be due to the compromised immune function of host and induced adaptability of pathogens during coinfections. As a result, new variants might be emerged when series of coinfection events occur during concurrent two epidemics.