Department of Nephrology,BIRDEM Geneal Hospital and Ibrahim Medical College,122, Kazi Nazrul Islam Avenue, Dhaka, Bangladesh
Department of Cardiology,NICVD,Sher-e-Banglanagar, Dhaka
Department of Internal Medicine,BIRDEM Geneal Hospital and Ibrahim Medical College,122, Kazi Nazrul Islam Avenue, Dhaka, Bangladesh
A case of
concurrent chikungunya virus and dengue virus infection is reported here. The patient
presented with fever and generalized body ache. Diagnostic work-up revealed
chikungunya-dengue co-infection. Dengue is endemic in Bangladesh while
chikungunya is a recently emerging infection. As both the viruses are
transmitted by a common vector, Aedes spp.,
such co-infections are likely to increase in coming years.
IMC J Med Sci 2018; 12(1): 42-43
Correspondence: Dr. Muhammad
Abdur Rahim, Assistant Professor, Department of Nephrology, BIRDEM General
Hospital and IMC, 122 Kazi Nazrul Islam
Avenue, Dhaka-1000, Bangladesh. Email: email@example.com
and dengue are two important and rapidly spreading mosquito-borne viral
infections of global concern including Bangladesh. Dengue is endemic and
chikungunya is an emerging infection in Bangladesh [1-3]. Since both the
viruses are transmitted by Aedes mosquitoes,
simultaneous or sequential infections by chikungunya and dengue viruses are not
impossible. Here, we report a case of chikungunya-dengue co-infection occurring
in a middle aged Bangladeshi patient.
50-year-old lady presented with 3-day history of high grade continued fever and
generalized body ache. She suffered a 5-day long febrile illness starting 15
days ago. Since the onset of fever for the first time, she had been
experiencing pain in her hands and feet. She took paracetamol tablets during
febrile periods and did not seek any medical advice before presenting to our
examination, patient was febrile (temperature 102°F) but hemodynamically stable
[pulse 92/min, blood pressure 130/80 mm Hg]. There was no rash or
lymphadenopathy. Other physical examination findings were unremarkable.
revealed leucopenia [total white blood cell (WBC) count 2.5x109/L],
lower normal platelet counts (150x109/L) and slightly raised erythrocyte
sedimentation rate (25 mm in 1st hour). Both dengue nonstructural
protein 1 (NS1) and immunoglobulin M (IgM) for chikungunya were positive by immuno-chromatographic
test (Dengue NS1 by Humasis Co. Ltd., Republic of Korea; chikungunya IgM/IgG by
SD BIOSENSOR, Republic of Korea). A diagnosis of chikungunya-dengue
co-infection was made. She was treated with paracetamol and became afebrile
after 5 days. Pain in feet continued even two weeks after she became afebrile
and she was prescribed oral prednisolone 15 mg/day initially, with a plan to
gradually tapper off over three weeks.
and dengue virus co-infections have been reported from India , Thailand ,
Yemen  and among returning travelers from Colombia  and Angola . As
both the viruses share common vector, chikungunya-dengue co-infection is likely
to occur elsewhere. As chikungunya is a relatively new entity in Bangladesh ,
we did not find many cases of such co-infections, but we predict to deal
increasing number of such co-infections in coming years. In our clinical
practice, we dealt patients with chikungunya with evidences of past dengue infection
(positive anti-dengue IgG antibody; unpublished observations).
and dengue viruses share many similar epidemiological and clinical
characteristics. Both can cause fever, rash, body aches and pains; though
arthritis is more associated with chikungunya while retro-orbital pain is
frequently present in dengue [2,3]. Reverse-transcriptase polymerase chain
reaction (RT-PCR) technology is now-a-days available; which can efficiently
detect ribonucleic acids (RNAs) of chikungunya and dengue sufficiently early in
disease course. Leucopenia and thrombocytopenia are common in dengue whereas lymphocytopenia
and raised erythrocyte sedimentation rate favor diagnosis of chikungunya infection
[2,3]. Anti-chikungunya antibody (IgM) and anti-dengue antibody (IgM) may be
detected in later part of first week or at the beginning of second week.
Exclusion of dengue is more important than establishing chikungunya virus
infection during febrile periods, as patients may require non-steroidal
anti-inflammatory drugs (NSAIDs), which is not advocated during dengue
infection . Not only that, dengue has a higher mortality (0.5-3.5%) than
chikungunya (<0.1%) and simultaneous infections by both viruses may result
in serious disease though controversies exist .
other vector borne disease, mosquito control is an important intervention to
prevent dengue and chikungunya infections. Confining patients suffering from chikungunya
and dengue under mosquito nets during viremic stage is an important
intervention against disease transmission . Creating and improving mass
awareness, cleaning mosquito breeding sites as well as other public health
measures are necessary to effectively reduce the burden of chikungunya and
dengue infections in Bangladesh.
and managed the cases, collected data, did literature search and drafted the
manuscript, SH did literature search and helped in manuscript preparation, SRA,
HFH, FH and TS followed up cases, collected data and edited the manuscript, KNU
was the overall supervisor in diagnosing and managing cases and manuscript
Authors declare no conflict of interest.
1. Furuya-Kanamori L,
Liang S, Milinovich G, Magalhaes RJS, Clements ACA, Hu W, et al. Co-distribution and co-infection of chikungunya and dengue
viruses. BMC Infect Dis. 2016; 16: 84.
JU, Rahim MA, Uddin KN. Emerging Viral Diseases.
BIRDEM Med J. 2017; 7(3):
3. Rahim MA, Uddin KN. Chikungunya: an emerging
viral infection with varied clinical presentations in Bangladesh. Reports of
seven cases. BMC Res Notes. 2017; 10: 410.
4. Saswat T, Kumar A, Kumar S, Mamidi P, Muduli
S, Debata NK, et al. High rates of
co-infection of Dengue and Chikungunya virus in Odisha and Maharashtra, India
during 2013. Infect Genet Evol. 2015;
5. Laoprasopwattana K, Suntharasaj T, Petmanee
P, Suddeaugrai O, Geater A. Chikungunya and dengue virus infections during
pregnancy: seroprevalence, seroincidence and maternal-fetal transmission,
southern Thailand, 2009-2010. Epidemiol
Infect. 2016; 144(2): 381-88.
6. Rezza G, El-Sawaf G, Faggioni G, Vescio F, Al
Ameri R, De Santis R, et al.
Co-circulation of Dengue and Chikungunya Viruses, Al Hudaydah, Yemen, 2012. Emerg Infect Dis. 2014; 20(8): 1351-54.
7. Rosso F, Pacheco R, Rodríguez S, Bautista D.
Co-infection by Chikungunya virus (CHIK-V) and dengue virus (DEN-V) during a
recent outbreak in Cali, Colombia: Report of a fatal case. Rev Chilena Infectol. 2016; 33(4): 464-67.
8. Parreira R, Centeno-Lima S, Lopes A,
Portugal-Calisto D, Constantino A, Nina J. Dengue virus serotype 4 and
chikungunya virus coinfection in a traveller returning from Luanda, Angola,
January 2014. Euro Surveill. 2014; 19(10).pii: 20730.