Background
Methods
Study location
Study population
Covariates included, data collection and statistical analysis
Ethical considerations
Results
Cases description
Dengue laboratory diagnosis | Co-infection n (%) | Dengue n (%) | Cases |
---|---|---|---|
Cell culture virus isolation and/or RT-PCR* | 9 (8.7) | 56 (26.9) | CADC§ |
NS1 antigen +/− IgM* | 11 (10.6) | 84 (40.4) | |
IgM + IgA* | 14 (13.5) | 9 (4.3) | |
IgM seroconversion | 7 (6.7) | 1 (0.5) | |
IgM | 63 (60.6) | 58 (27.9) | LDC§ |
Total |
104
|
208
|
Results n (%) | Co-infection (n = 104) | Malaria (n = 208) | p** |
---|---|---|---|
Males
| 75 (72.1) | 162 (77.9) | 0.26 |
Children (<15 years-old)
| 11 (10.6) | 18 (8.7) | 0.58 |
Journey in forest
| 26 (25) | 51 (24.6) | 0.96 |
Inhabitant of the coast
¥
| 86 (83.5) | 151 (74.4) | 0.11 |
Long admission (≥2 days)
| 43 (41.3) | 72 (34.6) | 0.25 |
Admission
| 37 (35.6) | 69 (33.2) | 0.67 |
Medical history of malaria
| 52 (50) | 115 (62.8) | 0.02§ |
Time since last malaria attack < 90 days
| 19 (55.9) | 49 (51.6) | 0.91 |
Medical history of dengue
| 3 (3.4) | 16 (9) | 0.08§§ |
Duration of fever > 5 days
| 48 (48.5) | 61 (29.9) | 0.001§ |
Red cells transfusion
| 8 (7.7) | 3 (1.4) | 0.01§ |
Tachycardia (>90 bpm)
| 79 (79) | 165 (82.1) | 0.64 |
Hypotension (<90 mmHg)
| 10 (10.4) | 7 (3.6) | 0.01§ |
Fever ≥ 40°C
| 15 (14.7) | 24 (11.9) | 0.47 |
Retro-orbital pain
| 4 (3.9) | 10 (5) | 0.61 |
Chills
| 36 (35.6) | 64 (32.2) | 0.7 |
Hemorrhagic signs
| 12 (11.5) | 25 (12.4) | 0.81 |
Shock signs
| 7 (6.8) | 8 (4) | 0.16§§ |
Rash
| 1 (1) | 5 (2.5) | 0.4 |
Nausea and / or vomiting
| 58 (56.9) | 93 (45.8) | 0.06§§ |
Neurological disorders
| 7 (6.8) | 5 (2.5) | 0.08§§ |
Dehydration
| 7 (7.4) | 10 (5) | 0.37 |
Mucocutaneous pallor
| 11 (11.6) | 7 (3.5) | 0.02§ |
Splenomegaly
| 9 (12.3) | 23 (18.3) | 0.08§ |
Mucocutaneous jaundice
| 9 (8.7) | 9 (4.3) | 0.14§§ |
ENT symptoms
| 6 (5.8) | 10 (4.8) | 0.72 |
Severe “malaria” cases††
| 34 (32,7) | 39 (18,7) | 0,007 |
Low parasitaemia (class < 3)
| 20 (19.2) | 24 (11.5) | 0.08§§ |
Mildly low hemoglobin (<12 g/dl)
| 37 (35.6) | 43 (20.7) | 0.05§§ |
Low hematocrit (<36%)
| 43 (41.3) | 49 (23.6) | 0.002§ |
Deep thrombocytopenia (<50 G/L)
| 23 (22.1) | 25 (12) | 0.02§ |
Low prothrombin (<70%)
| 14 (21.2) | 22 (15.4) | 0.33 |
Hyponatremia (<130)
| 7 (7.1) | 15 (7.4) | 0.87 |
Hypokalemia (<3)
| 6 (6.1) | 15 (7.4) | 0.67 |
Elevated creatinin (>111 μmol/L)
| 4 (4) | 14 (7) | 0.29 |
Elevated bilirubin (>50 μmol/L)
| 16 (16.8) | 20 (10.5) | 0.06 |
SGPT (>2 N)
| 10 (10.2) | 33 (16.7) | 0.16§ |
SGOT >2 N
| 13 (13.3) | 23 (11.6) | 0.66 |
CRP <5
| 2 (2) | 1 (0.5) | 0.22 |
CRP 5 à 50
| 29 (29) | 78 (38) | - |
CRP > 50
| 69 (69) | 126 (61.5) | - |
Comparison of co-infection with dengue
Results n (%) | Co-infection (n = 104) N (%) | Dengue (n = 208) N (%) |
p*
|
---|---|---|---|
Males
| 75 (72.1) | 119 (57.2) | 0.01§ |
Children (<15 years-old)
| 11 (10.6) | 49 (23.6) | 0.008§ |
Journey in forest
| 26 (25) | 7 (3.4) | <0.001§ |
Living on the coast
¥
| 86 (83.5) | 183 (92.9) | 0.025§ |
Long admission (≥2 days)
| 43 (41.3) | 71 (34.1) | 0.23 |
Admission
| 37 (35.6) | 45 (21.6) | 0.01§ |
Medical history of malaria
| 52 (50) | 21 (10.2) | <0.001§ |
Time since last malaria attack < 90 days
| 15 (44.1) | 0 (0) | - |
Medical history of dengue
| 3 (3.4) | 5 (2.7) | 0.64 |
Duration of fever > 5 days
| 48 (48.5) | 33 (16.3) | <0.001§ |
Red cells transfusion
| 8 (7.7) | 2 (1) | 0.03§ |
Tachycardia (>90 bpm)
| 79 (79) | 128 (64.6) | 0.03§ |
Hypotension (<90 mmHg)
| 10 (10.4) | 3 (1.8) | 0.02§ |
Fever ≥ 40°C
| 15 (14.7) | 10 (4.9) | 0.006§ |
Retro-orbital pain
| 4 (3.9) | 26 (12.6) | 0.01§ |
Chills
| 36 (35.6) | 37 (18) | 0.002§ |
Hemorrhagic signs
†
| 12 (11.5) | 32 (15.5) | 0.31 |
Shock signs
‡
| 7 (6.8) | 5 (2.4) | 0.06§§ |
Rash
| 1 (1) | 30 (14.6) | 0.007§ |
Neurological disorders
| 7 (6.8) | 8 (3.9) | 0.28 |
Nausea and / or vomiting
| 58 (56.9) | 94 (45.6) | 0.07§§ |
Dehydration
| 7 (7.4) | 4 (1.9) | 0.04§ |
Mucocutaneous pallor
| 11 (11.6) | 3 (1.5) | 0.003§ |
Splenomegaly
| 9 (12.3) | 3 (3.1) | 0.04§ |
Jaundice
| 9 (8.7) | 6 (2.9) | 0.03§ |
ENT symptoms
| 6 (5.8) | 42 (20.2) | 0.002§ |
Severe “malaria” cases
††
| 34 (32,7) | 33 (15,9) | <0,001 |
Confirmed acute dengue cases
| 41 (39.4) | 150 (72.1) | <0.001§ |
Mildly low hemoglobin (<12 g/dl)
| 37 (35.6) | 40 (19.2) | 0.002§ |
Low hematocrit (<36%)
| 43 (41.3) | 34 (16.4) | <0.001§ |
Deep thrombocytopenia (<50 G/L)
| 23 (22.1) | 6 (2.9) | <0.001§ |
Low prothrombin (<70%)
| 14 (21.2) | 19 (13.9) | 0.18§§ |
Hyponatremia (<130)
| 7 (7.1) | 5 (2.5) | 0.08§§ |
Hypokalemia (<3)
| 6 (6.1) | 3 (1.5) | 0.04§ |
Elevated creatinin (>111 μmol/L)
| 4 (4) | 4 (2) | 0.3 |
Elevated bilirubin (>50 μmol/L)
| 16 (16.8) | 3 (1.6) | <0.001§ |
SGPT (>2 N)
| 10 (10.2) | 32 (16) | 0.2 |
SGOT >2 N
| 13 (13.3) | 41 (20.5) | 0.16§§ |
CRP <5
| 2 (2) | 73 (35.3) | <0.001§ |
CRP 5 à 50
| 29 (29) | 115 (55.6) | - |
CRP > 50
| 69 (69) | 19 (9.2) | - |
Outcome | Bivariate analysis | Multivariate analysis | Sensitivity (%) | Specificity (%) | |||||
---|---|---|---|---|---|---|---|---|---|
OR* | 95% CI* | p* | OR** | 95% CI** | p** | ||||
Co-infection versus dengue |
Confirmed acute dengue cases
| 5.3 | 2.9-9.7 |
<0.001
|
4.5
|
1.7-11.9
|
0.003
| 79.1 | 52.1 |
Males
| 1.9 | 1.2-3.2 | 0.01 | 3.4 | 1.1-10.3 |
0.03
| 38.7 | 75.4 | |
Low hematocrit (<36%)
| 4.3 | 2.3-8.2 | <0.001 | 8.4 | 2.2-32-5 |
0.002
| 53.5 | 74.3 | |
Deep thrombocytopenia (<50. 10
9
/L)
| 13.8 | 4.1-46 | <0.001 | 11.7 | 1.7-79.2 |
0.01
| 79.3 | 71.4 | |
CRP 5 to 50 mg/L
| 5.0 | 1.1-21.7 | <0.001 | 5.3 | 0.9-29.3 | 0.06 | - | - | |
CRP >50 mg/L
| 75.4 | 16-356.7 | <0.001 | 74.4 | 12.2-453.3 | <0.001 | 78.4 | 85.8 | |
Co-infection versus malaria |
Red cells transfusion
| 7.3 | 1.5-34.7 | 0.01 | 5.3 | 1.04-26.7 |
0.04
| 72.7 | 68.1 |
Low hematocrit (<36%)
| 2.2 | 1.3-3.6 | 0.002 | 2 | 1.2-3.5 |
0.009
| 46.0 | 72.6 | |
Deep thrombocytopenia (<50. 10
9
/L)
| 2.2 | 1.1-4.1 | 0.02 | 2.1 | 1.02-4.1 |
0.04
| 47.9 | 69.3 | |
Low parasitic load (class < 3)
| 1.8 | 0.9-3.3 | 0.08 | 2.2 | 1.08-4.3 |
0.03
| 45.4 | 68.6 |