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Open AccessCase Report

Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas

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Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira 66003, Colombia
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Infection and Immunity Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira 66003, Colombia
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Secretary of Health of Ibagué, Ibague, Tolima 730001, Colombia
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School of Medicine, Faculty of Health Sciences, Universidad de Tolima, Ibagué, Tolima 730001, Colombia
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Secretary of Health of Tolima, Ibague, Tolima 730001, Colombia
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Medical School, Universidad Privada Franz Tamayo UNIFRAZ, Cochabamba 4780, Bolivia
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2018, 3(4), 123; https://doi.org/10.3390/tropicalmed3040123
Received: 6 November 2018 / Revised: 19 November 2018 / Accepted: 20 November 2018 / Published: 26 November 2018
The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death. View Full-Text
Keywords: dengue; chikungunya; Leptospira; co-infection; Colombia; Latin America dengue; chikungunya; Leptospira; co-infection; Colombia; Latin America
MDPI and ACS Style

Cardona-Ospina, J.A.; Jiménez-Canizales, C.E.; Vásquez-Serna, H.; Garzón-Ramírez, J.A.; Alarcón-Robayo, J.F.; Cerón-Pineda, J.A.; Rodríguez-Morales, A.J. Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas. Trop. Med. Infect. Dis. 2018, 3, 123.

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