Severe dengue associated withStaphylococcus aureussepsis in pediatric patients: a case series

Abstract

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.

Pyopericardium progressing to cardiac tamponade in a patient with dengue fever

“…Currently, Gram-negative enteric bacteria and fungi ( Candida and Aspergillus species) are increasing in frequency [6] . Massive pyopericardium leading to cardiac tamponade is uncommon in disseminated staphylococcal disease and requires prompt drainage and antibiotics [7] .…”

Frequency, Markers and Costs of Secondary Bacterial Infection in Pediatric Dengue

“…[4][5][6] Expectedly, the frequency of SBI was higher in children with SD, who are known to manifest most of the immune alterations described, as previously noted. 12,13 Adult patients with SD also have a higher risk of bacterial coinfection. 4,6 Importantly, although we did not observe higher mortality in the group with SBI, we did observe a higher predisposition to develop organ dysfunction.…”

“…These data are in line with recent reports of bacterial coinfection in pediatric dengue. [12][13][14] Previous studies have also proposed the use of procalcitonin for the identification of adult dengue patients with bacteremia in the intensive care unit. 50 However, procalcitonin measurement is not always available in low-resource settings, as is leukocyte and CRP evaluation.…”

“…11 Few reports of pediatric dengue have shown that SBI preferentially occurs in children <5 years old with severe DENV infection, and they are characterized by prolonged fever and longer hospital stay. [12][13][14] However, clinical and laboratory markers at hospital admission that would help to identify children with dengue who course with SBI are lacking. These biomarkers would inform appropriate microbiological investigations of SBI and start early antibiotic therapy, preventing morbidity and mortality.…”