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Coinfection with Respiratory Pathogens and Dengue Disease Severity in Puerto Rico, 2012-2024
Matthew J Lozier1,2, Diego M Canabal López3, Brenda Torres-Velásquez1
1Centers for Disease Control and Prevention, San Juan, Puerto Rico.
The American Journal of Tropical Medicine and Hygiene
|August 5, 2025
Summary
Dengue virus (DENV) coinfections with other pathogens are uncommon in acute febrile illnesses in Puerto Rico, primarily involving respiratory viruses. Comprehensive testing is crucial due to overlapping symptoms complicating patient management.
Area of Science:
- Epidemiology
- Infectious Diseases
- Virology
Background:
- Differentiating arboviral infections like dengue virus (DENV) from other pathogens is challenging, especially with coinfections.
- Recognizing DENV coinfections is vital for managing disease severity and guiding patient care decisions.
- Coinfections can complicate diagnosis and treatment of acute febrile illnesses (AFIs).
Purpose of the Study:
- To compare clinical and demographic features of DENV monoinfection versus DENV coinfection in Puerto Rico.
- To identify the prevalence and types of pathogens coinfecting with DENV.
- To assess the impact of DENV coinfection on disease severity and hospitalization.
Main Methods:
- Analysis of data from the Sentinel Enhanced Dengue Surveillance System in Puerto Rico (2012-2024).
- Pathogen identification using nucleic acid detection (real-time RT-PCR) and serology.
- Statistical comparison of demographic and clinical features using Mann-Whitney-Wilcoxon, chi-squared, and Fisher's exact tests.
Main Results:
- Out of 50,189 participants tested for DENV, 1,218 (2.4%) had DENV infections, with 46 (3.8%) being coinfections.
- The most common coinfecting pathogens were adenovirus, influenza A, human metapneumovirus, and respiratory syncytial virus.
- DENV coinfections were associated with younger age and symptoms like rhinorrhea and cough; severe dengue indicators were not significantly associated with coinfection.
Conclusions:
- DENV coinfections are infrequent in Puerto Rican AFI cases, predominantly involving respiratory viruses.
- Overlapping symptoms between DENV and coinfecting viruses can complicate clinical diagnosis and management.
- Comprehensive pathogen testing is essential in regions with co-circulating arboviruses and respiratory viruses.
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