Raina Sujeet, Raina Rashmi Kaul, Agarwala Niraj, Raina Sunil Kumar, Sharma Rajesh
Department of Medicine, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.
Department of Pathology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.
J Vector Borne Dis. 2018 Apr-Jun;55(2):130-136. doi: 10.4103/0972-9062.242560.
BACKGROUND & OBJECTIVES: In India, certain geographic regions witness simultaneous outbreaks of two or more diseases like scrub typhus, dengue fever, malaria, leptospirosis and chikungunya during monsoon and post-monsoon period, sharing common indication of acute febrile illness. The objective of the present study was to assess the prevalence of coinfections among patients with acute undifferentiated fevers (AUF) admitted in a tertiary care hospital in the northern hilly state of Himachal Pradesh, India.
This was a hospital based open cohort study conducted over a period of two months (September and October) in 2016. All the patients above the age of 18 yr admitted in medical wards and fulfilling the definition of AUF were included. The patients diagnosed with dual infections were the subjects of the study. Standard guidelines were used for case definitions of scrub typhus, dengue, chikungunya, malaria and leptospirosis.
Dual infections were noted in 16 patients admitted with AUF. The most common coinfection was scrub typhus and dengue, reported in 10 patients. Scrub typhus and leptospirosis coinfection was observed in three patients. Dengue and chikungunya was observed in one patient. Scrub typhus, dengue and vivax malaria was detected in one patient. Scrub typhus and vivax malaria was detected in one patient. Out of the 10 cases positive for both scrub and dengue, four had no history of travel outside Himachal Pradesh. All three cases positive for both scrub and leptospirosis were indigenous without any history of travel outside Kangra, Himachal Pradesh. The outcome of all the patients was with full recovery.
INTERPRETATION & CONCLUSION: The study established the presence of coinfections (mainly dengue fever and leptospirosis) as a cause of AUF in the study area, which is a nonendemic region. The role of easily available and widely performed serological tests in the aetiological diagnosis of AUF is significant. Studies are required to determine the normal titres in the local population before using the imported commercially available serological tests in the diagnosis of AUF.
在印度，某些地理区域在季风期和季风后期会同时爆发两种或更多疾病，如恙虫病、登革热、疟疾、钩端螺旋体病和基孔肯雅热，这些疾病都有急性发热性疾病的共同表现。本研究的目的是评估在印度喜马偕尔邦北部山区一家三级护理医院收治的急性未分化发热（AUF）患者中合并感染的患病率。
这是一项基于医院的开放队列研究，于2016年进行了两个月（9月和10月）。纳入所有年龄在18岁以上、入住内科病房且符合AUF定义的患者。被诊断为双重感染的患者为研究对象。恙虫病、登革热、基孔肯雅热、疟疾和钩端螺旋体病的病例定义采用标准指南。
16例AUF患者被发现存在双重感染。最常见的合并感染是恙虫病和登革热，有10例报告。3例患者观察到恙虫病和钩端螺旋体病合并感染。1例患者观察到登革热和基孔肯雅热合并感染。1例患者检测到恙虫病、登革热和间日疟。1例患者检测到恙虫病和间日疟。在10例恙虫病和登革热均呈阳性的病例中，4例没有喜马偕尔邦以外的旅行史。所有3例恙虫病和钩端螺旋体病均呈阳性的病例均为当地居民，没有喜马偕尔邦康格拉以外的旅行史。所有患者均完全康复。
该研究证实了在该研究区域（一个非流行地区），合并感染（主要是登革热和钩端螺旋体病）是AUF的一个病因。易于获得且广泛开展的血清学检测在AUF的病因诊断中具有重要作用。在使用进口的市售血清学检测诊断AUF之前，需要开展研究以确定当地人群的正常滴度。
