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Published on: February 9, 2011
Severe dengue associated with Staphylococcus aureus sepsis in pediatric patients: a case series
K C Sudeep1, Surjeet Kumar1, Manjinder Singh Randhawa1
1Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
Insights
Staphylococcus aureus co-infection is rare in severe dengue cases among children. Persistent fever and pleural effusion beyond the critical phase may indicate S. aureus co-infection, warranting further investigation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Staphylococcus aureus co-infection is infrequently documented in pediatric severe dengue cases.
- This study investigates a series of children with severe dengue and concurrent S. aureus infection.
Purpose of the Study:
- To report on the clinical characteristics, management, and outcomes of children with severe dengue and S. aureus co-infection.
- To identify clinical indicators suggestive of S. aureus co-infection in severe dengue patients.
Main Methods:
- A retrospective study of five children admitted to the pediatric intensive care unit (PICU) between July and December 2021.
- Analysis of clinical data, microbiological findings (S. aureus isolation sites), antibiotic susceptibility, and patient outcomes.
Main Results:
- All five children presented with prolonged fever, persistent pleural effusion, thrombocytopenia, and elevated inflammatory markers (CRP, procalcitonin).
- S. aureus was isolated from pleural fluid, blood, and endotracheal aspirates. Most isolates were methicillin-sensitive S. aureus (MSSA).
- Complications included septic thromboemboli and cellulitis. Management involved prolonged antibiotics, mechanical ventilation, and chest tube drainage; all patients survived.
Conclusions:
- Persistent fever and pleural effusion beyond the critical phase in severe dengue, along with elevated C-reactive protein and procalcitonin, should raise suspicion for S. aureus co-infection.
- Prompt recognition and targeted antibiotic therapy are crucial for managing S. aureus co-infection in severe dengue, leading to favorable outcomes.
Background:
Staphylococcus aureus co-infection is seldom reported in children with severe dengue.
Methodology:
In this retrospective study, we reported five children with severe dengue and S. aureus co-infection admitted to pediatric intensive care unit (PICU) during July-December 2021.
Results:
All children had prolonged fever, persistence of bilateral pleural effusion beyond the critical phase, thrombocytopenia and raised inflammatory markers [C-reactive protein (CRP) and procalcitonin]. S. aureus was isolated from pleural fluid (n = 2, 40%), blood (n = 2, 40%) and endotracheal aspirate (n = 1, 20%). Four children (80%) grew methicillin-sensitive S. aureus, while 1 (20%) had methicillin-resistant S. aureus. Two children (40%) had septic thromboemboli in skin, and 1 (20%) had limb cellulitis. One child required anterior thoracotomy, pericardiectomy and bilateral pleural decortication, while all other children required intercostal chest tube drainage. All children required prolonged targeted antibiotics, invasive mechanical ventilation and had prolong stay in PICU and all of them survived.
Conclusion:
In children with severe dengue, persistence of fever, persistence of pleural effusion beyond critical phase and raised CRP and procalcitonin should raise suspicion of bacterial/S. aureus co-infection.
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