Case report: Case series of fatal Leptospira spp./dengue virus co-infections - Puerto Rico, 2010-2012

Nicole M. Pérez Rodríguez, Renee Galloway, Dianna M. Blau, Rita Traxler, Julu Bhatnagar, Sherif R. Zaki, Aidsa Rivera, Jose V. Torres, David Noyd, Xavier E. Santiago-Albizu, Brenda Rivera García, Kay M. Tomashek, William A. Bower, Tyler M. Sharp

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Co-infection with pathogens that cause acute febrile illness creates a diagnostic challenge as a result of overlapping clinical manifestations. Here, we describe four fatal cases of Leptospira species/dengue virus co-infection in Puerto Rico. Although all patients sought care early, antibiotic administration was delayed for most. Steroids were administered to all patients, in most cases before antibiotics. These cases show the need for clinicians evaluating patients in or recently returned from the tropics with acute febrile illness to consider both dengue and leptospirosis. Furthermore, they illustrate the need for nucleic acid- or antigen-based rapid diagnostic tests to enable timely patient diagnosis and management. In particular, antibiotic therapy should be initiated early for patients with suspected leptospirosis, and steroids should not be administered to patients with suspected dengue.

Original languageEnglish (US)
Pages (from-to)760-765
Number of pages6
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number4
StatePublished - Oct 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases


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