title: Fatal case of co-infection with dengue virus andNeisseria meningitidisduring a dengue epidemic in the state of Rio de Janeiro, Brazil.
abstract: BACKGROUND
  Dengue and meningococcal disease are caused by two different agents: a flavivirus and a Gram-negative bacterium, respectively. The first symptoms of both diseases can be indistinct and a rapid and accurate diagnosis is crucial, considering that both diseases are associated with high morbidity and mortality, representing a major public-health problem in Brazil.
  
  
  METHODS
  We report a fatal case of co-infection of dengue virus (DENV) andNeisseria meningitidisin a 54-year-old patient. The serum tested positive for DENV NS1 antigen, andN. meningitidisserogroup C was detected bynspA-PCR. Following the initial positive result for DENV infection, rRT-PCRwas performed and DENV-4 was confirmed.
  
  
  CONCLUSIONS
  Our report highlights the importance of accurate differential diagnosis during periods of high circulation of DENV, in order to provide adequate management and an improved outcome.
authors.affiliation: National Institute for Quality Control of Health - INCQS, FIOCRUZ , Rio de Janeiro , Brazil.
authors.forename: Ivano
authors.initials: I
authors.lastname: de Filippis
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institution, FIOCRUZ , Rio de Janeiro , Brazil.
authors.forename: Priscila Conrado
authors.initials: PC
authors.lastname: Guerra Nunes
authors.affiliation: National Institute for Quality Control of Health - INCQS, FIOCRUZ , Rio de Janeiro , Brazil.
authors.forename: Claudia Ferreira
authors.initials: CF
authors.lastname: de Andrade
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institution, FIOCRUZ , Rio de Janeiro , Brazil.
authors.forename: Bianca de Santis
authors.initials: BS
authors.lastname: Gonçalves
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institution, FIOCRUZ , Rio de Janeiro , Brazil.
authors.forename: Eliane Saraiva
authors.initials: ES
authors.lastname: de Araújo
authors.affiliation: State Secretary of Health, Rio de Janeiro, Brazil.
authors.forename: Itacirema de Oliveira
authors.initials: IO
authors.lastname: Bezerra
authors.affiliation: Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Ivan Rocha Ferreira
authors.initials: IR
authors.lastname: da Silva
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institution, FIOCRUZ , Rio de Janeiro , Brazil.
authors.forename: Rita Maria
authors.initials: RM
authors.lastname: Nogueira
authors.affiliation: Flavivirus Laboratory, Oswaldo Cruz Institution, FIOCRUZ , Rio de Janeiro , Brazil.
authors.forename: Ana Maria Bispo
authors.initials: AM
authors.lastname: de Filippis
keywords: Dengue; PCR; RT-PCR; diagnostic; meningococcal disease