Secondary Bacteraemia in Dengue patients with Prolonged Fever

Abstract

INTRODUCTION AND OBJECTIVES: In dengue infection, fever usually lasts 5- 7 days. Less than 5% develop Dengue Shock Syndrome due to fluid leakage. Some of the patients with third space fluid accumulation (TSFA) continue to have prolonged high fever. Few studies have shown growth of bacterial species in blood cultures which suggest secondary bacteraemia. This is probably caused by translocation of gut bacteria by disruption of intestinal mucosal and vascular integrity. Clear understanding of secondary bacterial infections is necessary to treat the severe dengue infections effectively. Our objective was to assess the prevalence and risk of bacteraemia in patients with dengue who had prolonged fever. METHODS: A prospective, descriptive study was conducted at the Professorial Medical Unit of Colombo North Teaching Hospital, Ragama. Forty six patients with seropositive, acute dengue infection and prolonged fever (>5 days) were recruited. Two sets of blood cultures were obtained Haematological and biochemical tests were carried out. Clinical diagnosis of TSFA (ascites/ pleural effusions) were recorded. None of the patients were treated with antibiotics prior to obtaining blood cultures. RESULTS: Thirty (65.2%) patients had no evidence of fluid leakage and none of them had positive blood culture isolate. Of the 16 (34.8%) patients who had third space leakage, 10 (62-5%) patients had positive blood culture growths; Coliforms (3), Staphalococcus aureus (2), Pseudomonas sp.(l), mixed growths (4). CONCLUSIONS: Patients with prolonged fever and fluid leakage are at risk of developing secondary bacteraemia compared to those without fluid leakage.