Dengue and typhoid co-infection: A case report from a tertiary care hospital in South India

Introduction: Acute undifferentiated febrile illness is the most common presenting symptom in both adults and children during the monsoon. Incidence of both vector- and water-borne diseases are highest during these seasons, co-infections of dengue with typhoid, malaria, leptospirosis, scrub typhus and other arboviruses can occur in endemic areas. Coinfections of dengue with typhoid have been reported sparsely and are known to present with overlapping symptoms making the clinical diagnosis difficult. Case Series: We report two confirmed cases of dengue and typhoid coinfection during the monsoon of 2013 from a tertiary care centre in Chennai. Both the patients presented with high grade fever with headache, myalgia and gastrointestinal symptoms. They were admitted to inpatient units with provisional diagnosis of dengue disease, both the patients were confirmed with the diagnosis of dengue, one patient was positive for dengue virus by Real time PCR and other was positive for dengue specific IgM. In view of the persistent fever and associated gastrointestinal symptoms various diagnostic test were performed, which showed that there was a co-infection with typhoid fever. Both the patients were treated with appropriate antibacterial agents and discharged after complete recovery. Conclusion: Dual infections are difficult to diagnose especially in endemic areas during the rainy season as patients present with undifferentiated fever. Co-infections have to be suspected in cases with atypical disease presentations or prolonged fever.