Viral co-infection with dengue and H1N1 virus in a critical care setting

We describe a 23-year-old man with no history of any other illness contacting H1N1 infection during convalescence from dengue fever. The patient had bilateral pneumonia with renal and hepatic dysfunction. The patient was treated successfully with osaltamivir and noninvasive ventilation along with other supportive measures. Despite multiorgan involvement and severe pulmonary involvement, he had a rapid improvement and did not require invasive ventilation. The possibility of the preceding or concomitant dengue viral infection reducing the severity of H1N1 infection was considered. It may be possible for two viruses to infect the same cell and as such, there may be interaction of the pathologic pathways of the two viruses, leading to change of virulence or altered host response. Such an interaction between the two viruses may be clinically important in the setting of the current H1N1 pandemic and the increased geographic distribution of the dengue virus.