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Revista Pan-Amazônica de Saúde

versão impressa ISSN 2176-6223versão On-line ISSN 2176-6223

Rev Pan-Amaz Saude v.1 n.4 Ananindeua dez. 2010

http://dx.doi.org/10.5123/S2176-62232010000400014 

CASE REPORT | RELATO DE CASO | RELATO DE CASO

 

Leptospirosis and dengue co-infection in a Brazilian Amazon patient

 

Coinfecção por leptospirose e dengue em um paciente da Amazônia brasileira

 

Coinfección por leptospirosis y dengue en un paciente de la Amazonía brasileña

 

 

Lucas Crociati Meguins; Honório Onofre de Medeiro Júnior

Divisão de Clínica Médica, Hospital de Aeronáutica de Belém, Belém, Pará, Brazil

Endereço para correspondência
Correspondence
Dirección para correspondencia

 

 


ABSTRACT

Leptospirosis and dengue are two major urban health problems associated with high mortality. Acute co-infection with leptospirosis and dengue is an extremely rare event. The aim of the present report is to describe the first case of leptospirosis and dengue co-infection in a patient from the Brazilian eastern Amazonia.

Keywords: Leptospirosis; Dengue; Communicable Diseases; Enzyme-Linked Immunosorbent Assay.


RESUMO

Leptospirose e dengue são dois dos principais problemas de saúde pública associados a altas taxas de mortalidade. A coinfecção aguda por leptospirose e dengue é extremamente rara. O objetivo deste relato é descrever o primeiro caso de coinfecção por leptospirose e dengue em um paciente originário da Amazônia oriental brasileira.

Palavras-chave: Leptospirose; Dengue; Doenças Transmissíveis; ELISA.


RESUMEN

Leptospirosis y dengue son dos de los principales problemas de salud pública asociados a altas tasas de mortalidad. La coinfección aguda por leptospirosis y dengue es extremamente rara. El objetivo de este relato es el de describir el primer caso de coinfección por leptospirosis y dengue en un paciente oriundo de la Amazonia oriental brasileña.

Palabras clave: Leptospirosis; Dengue; Enfermedades Transmisibles; Prueba ELISA.


 

 

INTRODUCTION

Leptospirosis and dengue are infectious diseases of global importance and are two of the many medical conditions responsible for undifferentiated febrile illness, especially in tropical and subtropical regions1,2,3,4. The annual incidence of leptospirosis is estimated to range from 0.1-1.0 per 100,000 in temperate climates to 10-100 per 100,000 in the humid tropics, and incidences greater than 100 per 100,000 are encountered during outbreaks and in high-exposure-risk groups5. Dengue fever is endemic in most tropical and subtropical areas of the world, and in 2007, nearly 1 million cases were reported in the Americas alone6. Additionally, dengue viruses have been found to be the most common arbovirus infections in western South America, accounting for 26% of febrile episodes7. However, leptospirosis and dengue co-infection is an extremely rare event, with only five cases previously reported in the English medical literature8,9,10,11.

The aim of the present report is to describe the first case of leptospirosis and dengue co-infection in a patient from the Brazilian eastern Amazonia.

 

CASE REPORT

A previously healthy 41-year-old Brazilian Amazon man, a resident of a region in which rodents and insects are common, was admitted with a five-day history of high fever (41oC); abdominal pain; nausea; non-bilious and non-projectile vomiting; chills; arthralgia; intense myalgias, especially in the inferior extremities; and anorexia. There was no indication of bleeding from any site. The patient's past medical history was unremarkable. On physical examination, the patient was febrile and dehydrated and had an erythematous rash all over the body. The liver was palpable 3 cm below the right costal margin, and the spleen was palpable 1.5 cm below the left costal margin. Laboratory analysis revealed that serum electrolytes and kidney function were normal. Routine hematological investigations showed 13,400 white blood cells/mm3 and 119,000 platelets/mm3. Liver tests showed alkaline phosphatase 531 U/L (normal 30-250), GGT 221 U/L (normal 15-90), AST 1432 U/L, and ALT 521 U/L. Electrocardiogram and chest x-ray were both within normal limits. The patient was managed symptomatically. Further investigations were directed to establish the specific etiology. A peripheral blood smear for malaria and a Widal test for enteric fever were negative. Serologic testing for hepatitis A, B and C and HIV was negative. Tube agglutination and ELISA-IgM serology for Leptospira were positive. Dengue IgM capture ELISA (MAC-ELISA) was also positive and confirmed acute infection by dengue virus type 1. The patient was maintained with medical support, and his condition improved. He was discharged 21 days after admission, at which time he was asymptomatic.

 

DISCUSSION

Leptospirosis and dengue are two infectious diseases of global importance and are two of the many medical conditions responsible for undifferentiated febrile illness, especially in tropical and subtropical regions1,2,3,4. Latin America, and particularly the Brazilian Amazon, represents an endemic region for these two infectious diseases due to the geographic and climatic aspects of the region and the socioeconomic characteristics of its population12,13,14,15.

Leptospirosis is a worldwide zoonotic disease caused by pathogenic leptospires belonging to the genus Leptospira; this disease affects predominantly men. Its annual incidence is estimated to range from 0.1-1.0 per 100,000 in temperate climates to 10-100 per 100,000 in the humid tropics, and incidences of more than 100 per 100,000 are encountered during outbreaks and in high-exposure-risk groups5. Dengue is an arbovirus-associated disease and is by far the most common arthropod-borne viral infectious disease responsible for human febrile illness in Latin America7,14,15. In the last ten years, Brazil has accounted for nearly 70% of reported dengue fever cases in the Americas and has seen a 45-fold increase in the incidence of dengue from 2000 to 200216. Although leptospirosis and dengue are commonly seen in regions with poor socioeconomic conditions, such as some locations in the Brazilian eastern Amazonia, co-infection with these two pathogens is an extremely rare event, with only five cases previously reported in the English medical literature8,9,10,11.

The vast overlapping spectrum of symptomatic manifestations of dengue and leptospirosis makes the clinical diagnosis challenging for treating physicians when acute co-infection is present. According to Kaur and John10, in such cases, when undifferentiated fever is the main symptom observed, the only way to establish a specific diagnosis and rule out other infectious diseases is by serologic testing. Oliveira et al17 demonstrated that many patients presenting with clinical symptoms of dengue are found to be positive for Leptospira sp. based on laboratory tests.

 

CONCLUSION

In conclusion, the present report reinforces the fact that leptospirosis and dengue are two important endemic infectious diseases in the Amazon region and have a similar clinical presentation. Therefore, laboratory testing is an important diagnostic tool and must be initiated as soon as clinical suspicion of both diseases is raised.

 

REFERENCES

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15 Flauzino RF, Souza-Santos R, Oliveira RM. Dengue, geoprocessing, and socioeconomic and environmental indicators: a review. Rev Panam Salud Publica. 2009 May;25(5):456-61. DOI:10.1590/S1020-49892009000500012. [Link]

16 Torres JR, Castro J. The health and economic impact of dengue in Latin America. Cad Saude Publica. 2007;23 Suppl 1:S23-31. DOI:10.1590/S0102-311X2007001300004 [Link]

17 Oliveira ACA. Detecção de Leptospira sp no sangue periférico de indivíduos com suspeita de dengue, em Fortaleza, no ano de 2008-2010. Rev Bras Med Trop. 2010;23 supl 1:241.

 

 

Correspondência / Correspondence / Correspondencia:
Lucas Crociati Meguins
Passagem São Cristóvão, 11.
Bairro: Guamá
CEP: 66065-670
Belém-Pará-Brazil
Tel.: +55 (91) 8183-8107
E-mail: lucascrociati@libero.it

Recebido em / Received / Recibido en: 15/11/2010
Aceito em / Accepted / Aceito en: 20/12/2010