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CASE REPORT
Year : 2001  |  Volume : 19  |  Issue : 4  |  Page : 206-207
 

Mixed infection due to leptospira and dengue in a patient with pyrexia


Department of Microbiology, TN Medical College and Nair Hospital, Mumbai- 400 008, India

Correspondence Address:
Department of Microbiology, TN Medical College and Nair Hospital, Mumbai- 400 008, India

 ~ Abstract 

A case of mixed infection due to Leptospira and Dengue in a two and a half-year-old girl with pyrexia is reported. Early detection and institution of appropriate therapy is crucial and lifesaving.

How to cite this article:
Rele M C, Rasal A, Despande S D, Koppikar G V, Lahiri K R. Mixed infection due to leptospira and dengue in a patient with pyrexia. Indian J Med Microbiol 2001;19:206-7


How to cite this URL:
Rele M C, Rasal A, Despande S D, Koppikar G V, Lahiri K R. Mixed infection due to leptospira and dengue in a patient with pyrexia. Indian J Med Microbiol [serial online] 2001 [cited 2019 Oct 22];19:206-7. Available from: http://www.ijmm.org/text.asp?2001/19/4/206/8191


The city of Mumbai in the month of July 2000 experienced heavy rainfall, continuously for over 48 hours. This led to intensive flooding, backflow of wastewater resulting in waterlogging over a period of 2 days. Following this episode there was a sudden increase in the number of cases reporting with pyrexia. A differential diagnosis of Malaria, Enteric fever, Viral hepatitis, Leptospirosis and Dengue was considered.
We report a case of pyrexia in a 2.5 year-old girl who was diagnosed as mixed infection due to Leptospira and Dengue. An optimal use of microbiological laboratory services was essential for an accurate diagnosis of these infections.

 ~ Case report Top

A 2.5 year-old girl, hailing from Kandivli, Mumbai presented with fever, anorexia for 4 days and oliguria for a day. Her past history was not significant. On examination, she revealed icterus, mild fever, liver palpable (2.5 cm) and spleen palpable (1 cm). She was drowsy on day 2 and other systemic examination was normal. Investigation on the first day showed:
BUN Value of 60mg%
S.Creatinine 3.7mg%
HBsAg was negative
Deranged LFT
Peripheral smear for malarial parasite was negative
Electrolytes were normal
Platelet count was normal
Urine examination by dark ground microscopy for Leptospira was negative
Blood was cultured for  Salmonella More Details species
On day 4, she had altered sensorium and stool was positive for occult blood. On day 5,sera for Leptospira by tube agglutination method (DENKA SEIKEN TEST KIT) was negative but, by IgM ELISA (SERION - VERION CLASSIC TEST KIT) was positive (50 IU/mL). Serum was found to be positive for Dengue IgM antibodies by IgM ELISA (NOVUM DIAGNOSTICA KIT), blood culture was negative for  Salmonella More Details species.
By day 7 (1 week), patient started accepting oral feeds. At the end of second week a repeat sera for IgM ELISA was still positive for Dengue and IgM ELISA for Leptospira showed a decrease in titre (31 IU/mL). Widal test was negative.
IgM ELISA for Leptospira was repeated in the third week and was positive (30 IU/mL). She was doing well on follow up and a repeat sera sample (4 week) has been asked for Leptospira and Dengue. The patient responded to Inj. Crystalline Penicillin (7.5 lacs unit/m/day for 14 days) and supportive line of therapy including IV fluids, whole blood and fresh frozen plasma.
To date only 2 cases of simultaneous serological evidence of Leptospira and Dengue infection have been reported in Barbados.[1]

 ~ Discussion Top

In an overcrowded city like Mumbai, with most of the sewage canals and drainage outlets choked, vast amounts of waste generated, provide an environment conducive to thespread of infections. Often overflow of wastewater and heaps of garbage attract a large amount of rodents and mosquitoes, which play an important role in spreading of infections like leptospirosis and dengue fever.[2],[3]
ELISA is a highly sensitive (71%) and specific (86.4%) test for measurement of antibodies in acute stages of illness of various infections. Great specificity can be achieved by using specific purified, recombinant or peptide antigens, this reduces false positivity and cross reactions.[4]
In this reported case early diagnosis was possible due to the availability of proper diagnostic facility in our institution and general awareness about the diseases. Hence, an optimal use of Microbiological Laboratory services is essential for an accurate diagnosis of leptospirosis and dengue in early stages of infections. 

 ~ References Top

1.Levett PN, Branch SL, Edwards CN. Detection of dengue infection in patients investigated for leptospirosis in Barbados. Am J of Tropical Medicine and Hygiene 2000; 62(1):112-114.  Back to cited text no. 1    
2.Peter Speelman, Leptospirosis, In: Harrison's Principle of internal medicine, 14th edition, Vol. 1:1036-1038.  Back to cited text no. 2    
3.C. J. Peters. Infections caused by arthropod - and rodent borne viruses. In: Harrision's Principle of internal medicine, 14th edition, 1998; Vol. 1: 1132 - 1146.  Back to cited text no. 3    
4.S.C. Sehgal, P. Vijaychari, S. Sharma, A. P. Suguman: LEPTO Dipstick: a rapid and simple method for serodiagnosis of acute leptospirosis. Transc of the Royal Society of Tropical Medicine and Hygiene 1999; 93: 161- 164.  Back to cited text no. 4    
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