Ngoi Soo Tein, Lee Yee Wan, Niek Wen Kiong, Kan Foong Kee, AbuBakar Sazaly, Ponnampalavanar Sasheela Sri La Sri, Idris Nuryana, Teh Cindy Shuan Ju
Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Pathogens. 2020 Mar 5;9(3):190. doi: 10.3390/pathogens9030190.
Concurrent bacteraemia in patients with dengue fever is rarely reported. We report a case of a patient who initially presented with symptoms typical of dengue fever but later succumbed to septic shock caused by hypervirulent methicillin-susceptible (MSSA). A 50-year-old female patient with hypertension and diabetes mellitus presented with typical symptoms of dengue fever. Upon investigation, the patient reported having prolonged fever for four days prior to hospitalization. Within 24 hours post-admission, the patient developed pneumonia and refractory shock, and ultimately succumbed to multiple-organs failure. Microbiological examination of the blood culture retrieved a pan susceptible MSSA strain. Genomic sequence analyses of the MSSA strain identified genes encoding staphylococcal superantigens (enterotoxin staphylococcal enterotoxin C 3 (SEC3) and enterotoxin-like staphylococcal enterotoxins-like toxin L (SElL)) that have been associated with toxic shock syndrome in human hosts. Genes encoding important toxins (Panton-Valentine leukocidins, alpha-haemolysin, protein A) involved in the development of staphylococcal pneumonia were also present in the MSSA genome. co-infections in dengue are uncommon but could be exceptionally fatal if caused by a toxin-producing strain. Clinicians should be aware of the risks and signs of sepsis in dengue fever, thus allowing early diagnosis and starting of antibiotic treatment in time to lower the mortality and morbidity rates.
登革热患者并发菌血症的情况鲜有报道。我们报告一例患者，该患者最初表现为典型的登革热症状，但后来死于由高毒力甲氧西林敏感金黄色葡萄球菌（MSSA）引起的感染性休克。一名患有高血压和糖尿病的50岁女性患者出现了典型的登革热症状。经调查，患者报告在住院前已持续发热四天。入院后24小时内，患者发展为肺炎和难治性休克，最终死于多器官功能衰竭。血培养的微生物学检查分离出一株对多种药物敏感的MSSA菌株。对该MSSA菌株的基因组序列分析鉴定出编码葡萄球菌超抗原的基因（肠毒素葡萄球菌肠毒素C 3（SEC3）和类肠毒素葡萄球菌类毒素L（SElL）），这些基因与人类宿主的中毒性休克综合征有关。MSSA基因组中还存在编码与葡萄球菌肺炎发展相关的重要毒素（杀白细胞素、α-溶血素、蛋白A）的基因。登革热合并感染并不常见，但如果由产毒菌株引起则可能极其致命。临床医生应意识到登革热患者发生败血症的风险和体征，从而实现早期诊断并及时开始抗生素治疗，以降低死亡率和发病率。
