Comparison between Three Rare Cases of Co-Infection with Dengue, Leptospira and Hepatitis E: Is Early Endothelial Involvement the Culprit in Mortality?

Co-infection in immunocompetent patients is rare. Though co-infection with dengue and leptospira cases is increasingly reported, a co-infection of this combination along with hepatitis E is rarely thought of. Until date only two case of triple co-infection have been reported world-wide. Here, we are reporting a patient with co-infection of dengue, leptospirosis and hepatitis E admitted to our intensive care unit. Early septic shock and increasing procalcitonin in dengue patient raised suspicion of co-infection. Our aim is to educate intensivists about this rare co-infection and hence that timely initiation of appropriate diagnostic, therapeutic and supportive measures can alter outcome favorably.