Related Experiment Video
Updated: May 6, 2026
Multiplexed Isothermal Amplification Based Diagnostic Platform to Detect Zika, Chikungunya, and Dengue 1
Published on: March 13, 2018
Unveiling Hyperinflammation in Severe Dengue With Coinfection Among Children: A Case Series
Adyasha Mishra1, Bibekananda Mukherjee2, Ratan Kumar2,1
1Department of Pediatrics, Tata Main Hospital, Jamshedpur, IND.
Abstract:
Dengue illness follows three phases: febrile, critical, and convalescent. Coinfection and hyperinflammatory response are common causes of the persistence of fever beyond the febrile phase of dengue. However, finding both these causes together in severe dengue cases is rarely reported in the literature. We present three cases of severe dengue who presented with persistent fever. The first case is of a 14-year-old girl who presented with dengue shock and culture-proven Acinetobacter sepsis. Later she was diagnosed with a hyperinflammatory response to infection and improved after intravenous immunoglobulin (IVIG) administration. The second case is of a 13-year-old boy who presented with severe dengue and culture-proven Burkholderia sepsis. He also had persistent fever despite appropriate treatment of infection which later improved after IVIG administration for hyperinflammation. The third case is of a 10-year-old girl who presented with severe dengue and encephalopathy. She was later diagnosed with coinfection with Japanese encephalitis and hyperinflammation. These cases highlighted that coinfection and hyperinflammatory response can both together complicate dengue infection.
Insights
Severe dengue cases with persistent fever were complicated by both coinfection and hyperinflammation. These rare combined factors highlight the complexity of managing severe dengue illness.
Area of Science:
- Infectious Diseases
- Immunology
- Critical Care Medicine
Background:
- Dengue fever progresses through febrile, critical, and convalescent phases.
- Persistent fever beyond the febrile phase in dengue can stem from coinfection or hyperinflammation.
- Simultaneous occurrence of coinfection and hyperinflammation in severe dengue is seldom documented.
Observation:
- Three severe dengue cases with persistent fever were analyzed.
- Case 1: A 14-year-old girl with dengue shock and Acinetobacter sepsis, treated with IVIG for hyperinflammation.
- Case 2: A 13-year-old boy with severe dengue and Burkholderia sepsis, treated with IVIG for hyperinflammation.
- Case 3: A 10-year-old girl with severe dengue, encephalopathy, and Japanese encephalitis coinfection, exhibiting hyperinflammation.
Findings:
- Coinfection with bacterial pathogens (Acinetobacter, Burkholderia) and viral agents (Japanese encephalitis) can occur in severe dengue.
- Hyperinflammatory response, a key factor in severe dengue, can coexist with coinfections.
- Intravenous immunoglobulin (IVIG) showed efficacy in managing hyperinflammation in these complex cases.
Implications:
- Recognizing combined coinfection and hyperinflammation is crucial for diagnosing and managing severe dengue.
- This presentation underscores the need for a comprehensive diagnostic approach in persistent febrile illnesses during dengue outbreaks.
- Understanding these dual complications can guide therapeutic strategies and improve patient outcomes in severe dengue.
