title: Secondary bacteraemia in adult patients with prolonged dengue fever.
abstract: BACKGROUND
  Although dengue management guidelines do not advice on use of antibiotics in dengue shock syndrome, unrecognised bactraemia is likely to contribute to morbidity and mortality.
  
  
  OBJECTIVE
  To assess the occurance of secondary bacteraemia in adult patients with prolonged dengue fever.
  
  
  METHODS
  A prospective study was conducted recruiting patients with confirmed acute dengue infection who had prolonged fever (>5 days). Two sets of blood cultures were taken in such patients prior to institution of antibiotic therapy. Demographic, clinical, haematological and biochemical parameters were recorded. Development of ascites and pleural effusions were detected using ultrasonography.
  
  
  RESULTS
  Fourty patients (52.5% males) with a mean age of 29.8 years (SD 13.6) were studied. The average duration of fever was 7.9 days (SD 1.8). Ten patients (25%) had bacterial isolates in their blood cultures; Staphylococcus aureus (n=2), coliforms (n=3), pseudomonas (n=1) and 4 had mixed growths. The culture positive group had severe body aches at admission and higher fever, third space fluid accumulation, a significant drop in platelets and a higher CRP.
  
  
  CONCLUSIONS
  A quarter of dengue patients with prolonged fever had a bacterial isolate. Culture positive patients appeared more ill with body aches and had higher degrees of fever during the latter part of the illness. Increased vascular permeability may predispose to bacterial seepage into blood. Although white cell count is not helpful in detecting bacteraemia, low platelet count and elevation of CRP seem to be helpful.
authors: Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka. ranjanp64@gmail.com.
authors: R
authors: R
authors: Premaratna
authors: D
authors: D
authors: Dissanayake
authors: F H D S
authors: FH
authors: Silva
authors: M
authors: M
authors: Dassanayake
authors: H J
authors: HJ
authors: de Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016470:Bacteremia / Q000097:blood / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000378:metabolism; D060085:Coinfection / Q000097:blood / Q000453:epidemiology*; D003715:Dengue / Q000097:blood / Q000453:epidemiology*; D018450:Disease Progression; D004756:Enterobacteriaceae Infections / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000097:blood / Q000453:epidemiology*; D017678:Sex Distribution; D013188:Sri Lanka / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000097:blood / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein