G. Anil Kumar1, Hema S. Bhaskar2
INTRODUCTION
Generally, in dengue shock syndrome antibiotics are not advised. But unrecognised bacterial infection is likely to contribute to morbidity and mortality, probably because of increased vascular permeability.
OBJECTIVES
To assess the incidence of secondary bacterial infection in adult patients with prolonged and severe dengue fever.
METHODS
A prospective study was conducted recruiting patients with confirmed acute dengue infection who had prolonged fever (>5 days). Prior to institution of antibiotic therapy, two sets of blood cultures were taken from patients. Demographic, clinical, haematological and biochemical parameters were recorded. Severity of fever & associated symptoms assessed. Ultrasonography done to find out development of ascites and pleural effusions.
RESULTS
Sixty patients (60.0% males) with a mean age of 33.5 years (SD 12.1) were studied. The average duration of fever was 6.9 days (SD 1.6). Fifteen patients (25%) had bacterial isolates in their blood cultures; Staphylococcus aureus (n=3), coliforms (n=7), pseudomonas (n=2) and 3 had mixed growths. The culture positive group had severe body aches and joints paint at admission and high grade fever, third space fluid accumulation and significant drop in platelets compared to culture-negative group.
CONCLUSIONS
A quarter of dengue patients with prolonged fever had a bacterial isolate. Culture-positive patients appeared more ill with body aches and had higher degrees of fever during the course of the illness. Increased vascular permeability may predispose to bacterial seepage into blood. Although white cell count is not helpful in detecting bacteraemia in dengue fever, low platelet count and severe symptoms at presentation may be helpful.
