Tropical medicine and infectious disease · 2026
Factors Associated with the Prevalence of Dengue-Leptospirosis Coinfection in Patients Hospitalized for Febrile Syndrome.
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Bance-Anicama Dina I, Diaz-Orihuela María M, Diaz-Orihuela Luz M, Morales-García Wilter C
Аннотация
BACKGROUND: In tropical regions, dengue and leptospirosis coexist and share a nonspecific clinical onset that hinders timely diagnosis. Coinfection may worsen the clinical course and increase mortality.
OBJECTIVE: To estimate the prevalence of dengue, leptospirosis, and coinfection among patients with febrile syndrome in Madre de Dios (Peru) and to identify associated clinical factors.
METHODS: Observational, analytical, cross-sectional, retrospective study conducted at a primary-level health facility. Clinical and laboratory records of patients with febrile syndrome seen in 2024 were analyzed. Categorical variables were summarized as frequencies (%) and numeric variables as mean ± SD or median [IQR]. Comparisons used chi-square or Fisher's exact test, Student's t test, or the Mann-Whitney U test, as appropriate. Associations were estimated using Poisson regression models with robust variance, adjusted for sex, reporting prevalence ratios (PRs) and 95% CIs. Analyses were performed in R 4.0.2.
RESULTS: A total of 226 patients were included. Positivity was 19.0% for dengue (43/226), 66.8% for leptospirosis (151/226), and 5.8% for coinfection (13/226). In the bivariate analysis, dengue was associated with higher temperature (p < 0.001), lower mean arterial pressure (p = 0.007), mucosal bleeding/ecchymosis (p = 0.049), and lower fluid intake (p = 0.021); temperature was also higher in coinfection (p = 0.021). In Poisson models, dengue was associated with tachycardia (PR = 5.69; 95% CI: 1.95-13.07; p < 0.001), temperature (PR = 1.61 per °C; 1.23-2.12; p = 0.001), bilateral polyarthralgia (PR = 2.55; 1.14-5.04; p = 0.012), and mucosal bleeding/ecchymosis (PR = 3.31; 0.94-8.37; p = 0.027). Leptospirosis was associated with male sex (PR = 0.78 vs. female; 0.65-0.94; p = 0.010) and fever (PR = 2.38; 1.17-6.03; p = 0.035). Leptospira-dengue coinfection was related to higher temperature (PR = 1.75 per °C; 1.05-3.01; p = 0.036).
CONCLUSIONS: Simple clinical signs such as fever/elevated temperature, tachycardia, bilateral polyarthralgia, and mucosal bleeding can help prioritize suspicion of dengue, leptospirosis, or coinfection; guide requests for dual testing (dengue-Leptospira), early hydration in dengue, and timely initiation of antibiotic therapy in leptospirosis. These findings support the development of integrated triage algorithms and strengthening access to molecular diagnostics in high-burden febrile syndrome settings.
OBJECTIVE: To estimate the prevalence of dengue, leptospirosis, and coinfection among patients with febrile syndrome in Madre de Dios (Peru) and to identify associated clinical factors.
METHODS: Observational, analytical, cross-sectional, retrospective study conducted at a primary-level health facility. Clinical and laboratory records of patients with febrile syndrome seen in 2024 were analyzed. Categorical variables were summarized as frequencies (%) and numeric variables as mean ± SD or median [IQR]. Comparisons used chi-square or Fisher's exact test, Student's t test, or the Mann-Whitney U test, as appropriate. Associations were estimated using Poisson regression models with robust variance, adjusted for sex, reporting prevalence ratios (PRs) and 95% CIs. Analyses were performed in R 4.0.2.
RESULTS: A total of 226 patients were included. Positivity was 19.0% for dengue (43/226), 66.8% for leptospirosis (151/226), and 5.8% for coinfection (13/226). In the bivariate analysis, dengue was associated with higher temperature (p < 0.001), lower mean arterial pressure (p = 0.007), mucosal bleeding/ecchymosis (p = 0.049), and lower fluid intake (p = 0.021); temperature was also higher in coinfection (p = 0.021). In Poisson models, dengue was associated with tachycardia (PR = 5.69; 95% CI: 1.95-13.07; p < 0.001), temperature (PR = 1.61 per °C; 1.23-2.12; p = 0.001), bilateral polyarthralgia (PR = 2.55; 1.14-5.04; p = 0.012), and mucosal bleeding/ecchymosis (PR = 3.31; 0.94-8.37; p = 0.027). Leptospirosis was associated with male sex (PR = 0.78 vs. female; 0.65-0.94; p = 0.010) and fever (PR = 2.38; 1.17-6.03; p = 0.035). Leptospira-dengue coinfection was related to higher temperature (PR = 1.75 per °C; 1.05-3.01; p = 0.036).
CONCLUSIONS: Simple clinical signs such as fever/elevated temperature, tachycardia, bilateral polyarthralgia, and mucosal bleeding can help prioritize suspicion of dengue, leptospirosis, or coinfection; guide requests for dual testing (dengue-Leptospira), early hydration in dengue, and timely initiation of antibiotic therapy in leptospirosis. These findings support the development of integrated triage algorithms and strengthening access to molecular diagnostics in high-burden febrile syndrome settings.