Dengue and swine flu: An existed co-infection in clinical practice

Sir,

The swine flu has become the big respiratory infectious disease around the world. In the tropical countries, where the basic sanitation is poor, the infection is still problematic. Clinically, swine flu usually presents as an acute febrile illness. Nevertheless, in the tropical world, there are many other infections that can cause acute febrile illness. Among several infections, the viral infections that can produce the high fever with chill in a short incubation period seem to make the differential diagnosis of swine flu difficult. Indeed, the incorrect presumptive diagnosis between the two diseases can be expected. According to a recent report by Lochindarat and Bunnag, dengue is on the list of the early presumptive diagnosis of swine flu. ^[1]

In some situations, a more difficult case of co-infection can be seen. Here, the authors would like to discuss on an interesting companion, swine flu accompanied with dengue. Due to the nature of acute viral infection of both diseases, it is extremely hard to correctly diagnose the co-infection. It is no doubt that this co-infection exists in the real clinical practice. According to a recent report from Thailand by Chaiwarith et al., ^[2] 3 out of 378 patients with swine (nearly 1%) had dengue as co-infection. Based on this interesting information, the determination of the possible co-infection among the two diseases is suggested. The possible clues for suspicious diagnosis include: a) acute febrile illness, b) co-presentation between respiratory and bleeding symptoms, c) CBC show lymphocytosis with atypical lymphocytosis and decreased platelet, d) abnormality of chest X ray, and e) history of living in or visiting to a dengue endemic area.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.115199