ArticleThe American journal of tropical medicine and hygiene2014
Case series of fatal Leptospira spp./dengue virus co-infections-Puerto Rico, 2010-2012.
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Article in The American journal of tropical medicine and hygiene, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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21citing papers in PubMed, 1 pooled it
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Prevalence of dengue and leptospirosis coinfection and associated mortality rates: a systematic review and meta-analysis.BMC infectious diseases · 2025Pooled it
- Coinfection with Respiratory Pathogens and Dengue Disease Severity in Puerto Rico, 2012-2024.The American journal of tropical medicine and hygiene · 2025Article
- Epidemiological, temporal, and geographic trends of leptospirosis in the United States, 2014-2020.PLoS neglected tropical diseases · 2025Article
- Dengue and leptospirosis coinfection: a case series.Journal of medical case reports · 2024Article
- Fatal acute undifferentiated febrile illness among clinically suspected leptospirosis cases in Colombia, 2016-2019.PLoS neglected tropical diseases · 2023Article
- Knowledge gaps in the epidemiology of severe dengue impede vaccine evaluation.The Lancet. Infectious diseases · 2022Review
- Assessment of the Current Surveillance System for Human Leptospirosis in Ecuador by Decision Analytic Modeling.Frontiers in public health · 2022Article
- Leptospirosis in febrile patients with suspected diagnosis of dengue fever.BMC research notes · 2021Article
- Leptospiral Infection, Pathogenesis and Its Diagnosis-A Review.Pathogens (Basel, Switzerland) · 2021Review
- Leptospirosis as an important differential of pulmonary haemorrhage on the intensive care unit: a case managed with VV-ECMO.Journal of intensive care · 2020Article
- Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana.Open forum infectious diseases · 2019Article
- The prevalence of Leptospira among invasive small mammals on Puerto Rican cattle farms.PLoS neglected tropical diseases · 2019Article
- Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas.Tropical medicine and infectious disease · 2018Article
- Bacterial coinfections in dengue virus disease: what we know and what is still obscure about an emerging concern.Infection · 2017Review
- Surveillance for Chikungunya and Dengue During the First Year of Chikungunya Virus Circulation in Puerto Rico.The Journal of infectious diseases · 2016Article
- Enhanced Surveillance for Fatal Dengue-Like Acute Febrile Illness in Puerto Rico, 2010-2012.PLoS neglected tropical diseases · 2016Article
- Redefining Gold Standard Testing for Diagnosing Leptospirosis: Further Evidence from a Well-Characterized, Flood-Related Outbreak in Sri Lanka.The American journal of tropical medicine and hygiene · 2016Article
- Fatal case of co-infection with dengue virus andJMM case reports · 2016Article
- Early Indicators of Fatal Leptospirosis during the 2010 Epidemic in Puerto Rico.PLoS neglected tropical diseases · 2016Article
- Leptospirosis: risk factors and management challenges in developing countries.Research and reports in tropical medicine · 2016Review
Corrections and comments
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Authors and funding
14 authors at 1 institution in 1 country.
Nicole M Pérez RodríguezDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Renee GallowayDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Dianna M BlauDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Rita TraxlerDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Julu BhatnagarDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Sherif R ZakiDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Aidsa RiveraDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Jose V TorresDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
David NoydDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Xavier E Santiago-AlbizuDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Brenda Rivera GarcíaDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Kay M TomashekDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
William A BowerDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico.
Tyler M SharpDivision of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico tsharp@cdc.gov.
Centers for Disease Control and Prevention · US
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
Indexed as
AdultAgedAnti-Bacterial AgentsCoinfectionDengueDengue VirusFatal OutcomeHumansLeptospiraLeptospirosisMaleMiddle AgedPuerto RicoSteroidsYoung AdultAnti-Bacterial AgentsSteroids
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