Pune: Amid the ongoing surge in seasonal illnesses in the city, reports are also coming in of patients with dengue and
chikungunya coinfections, doctors said this week, raising concerns of serious complications from dual infection.
Medical experts TOI spoke to said the concurrent infections do have the potential to cause a more debilitating set of symptoms.
"Chikungunya and dengue coinfection can, for instance, put the patient at risk of delayed or disrupted dengue-specific supportive care," said Dr Rajesh Kulkarni, a pediatrician at Pimpri's YCM Hospital.
He said: "There is also a risk of stronger pain relief medications like NSAIDs being prescribed to patients with chikungunya, which could potentially lead to lower platelet counts in those with dengue-chikungunya coinfections."
Dr Kulkarni said while management of both diseases remains largely symptomatic, coinfections can be more painful for some. "These patients may experience the intense body aches of dengue along with the joint pain that's characteristic of chikungunya, all together," he said.
Such coinfections are possible but thankfully, are rare, said Dr Awanti Golwilkar-Mehendale, director and chief of laboratory at Pune-based AG Diagnostics.
"They have an occurrence rate of about 1-2.5% in the cases tested at the lab. Both chikungunya and dengue are transmitted through mosquito bites, so it is possible for a mosquito to carry and transmit both viruses simultaneously, if it has bitten one individual with chikungunya and another with dengue," she said, adding that coinfections can "complicate" clinical diagnosis.
"Both diseases share similar symptoms, including fever, body aches and joint pain. However, chikungunya is more likely to cause prolonged joint inflammation and swelling, while dengue can lead to a more severe drop in platelet count. Therefore, a patient with coinfection may experience compounded symptoms, making it feel like a battle against two illnesses at once. When coinfection is suspected, careful monitoring of platelet levels and symptomatic treatment is key," she said.
Dr Golwilkar-Mehendale said PCR tests can be deployed to check if coinfection is present in a patient.
"In rare cases, detection of both chikungunya and dengue antibodies in the same patient may be due to cross-reactivity rather than coinfection, as the body's immune system may have produced antibodies in response to previous exposures. Cross-reactivity between antibodies can sometimes lead to confusion in diagnosing coinfections. To resolve such cases, a PCR test can help confirm the presence of active infections of both viruses," she said.
Dr Ameet Dravid, an infectious disease expert from Noble Hospital, said: "Coinfections involving chikungunya, dengue, zika and even salmonella have been observed, though they are not necessarily more severe than a single predominant infection. In cases of coinfection, one virus typically dominates, causing the majority of complications."
However, Dr Dravid said there have been cases in which a coinfection led to serious outcomes. "We had a patient with both chikungunya and salmonella infection, which led to complications such as encephalitis, requiring the patient to be placed on a ventilator. This highlights the fact that while coinfections may not always increase overall severity, they can complicate the clinical picture, especially if the predominant infection is particularly aggressive," he said.
Dr Devashish Desai, consultant of infectious diseases at Ruby Hall Clinic, said: " This year, I have personally seen only two patients with coinfection, but such cases are likely to be more widespread. There have even been cases of patients infected with dengue, chikungunya and zika all simultaneously, as all three are spread by the same mosquito."
Dr Desai said in terms of symptoms, patients are often first identified as having dengue fever, due to its rather distinct effects such as high fever and a drop in platelets. "But when people experience joint pain, beyond the usual body ache and red eyes, we also test for chikungunya. A positive test for chikungunya confirms a coinfection of both dengue and chikungunya."
Pune: Amid the ongoing surge in seasonal illnesses in the city, reports are also coming in of patients with dengue and chikungunya coinfections, doctors said this week, raising concerns of serious complications from dual infection.
Medical experts TOI spoke to said the concurrent infections do have the potential to cause a more debilitating set of symptoms.
"Chikungunya and dengue coinfection can, for instance, put the patient at risk of delayed or disrupted dengue-specific supportive care," said Dr Rajesh Kulkarni, a pediatrician at Pimpri's YCM Hospital.
He said: "There is also a risk of stronger pain relief medications like NSAIDs being prescribed to patients with chikungunya, which could potentially lead to lower platelet counts in those with dengue-chikungunya coinfections."
Dr Kulkarni said while management of both diseases remains largely symptomatic, coinfections can be more painful for some. "These patients may experience the intense body aches of dengue along with the joint pain that's characteristic of chikungunya, all together," he said.
Such coinfections are possible but thankfully, are rare, said Dr Awanti Golwilkar-Mehendale, director and chief of laboratory at Pune-based AG Diagnostics.
"They have an occurrence rate of about 1-2.5% in the cases tested at the lab. Both chikungunya and dengue are transmitted through mosquito bites, so it is possible for a mosquito to carry and transmit both viruses simultaneously, if it has bitten one individual with chikungunya and another with dengue," she said, adding that coinfections can "complicate" clinical diagnosis.
"Both diseases share similar symptoms, including fever, body aches and joint pain. However, chikungunya is more likely to cause prolonged joint inflammation and swelling, while dengue can lead to a more severe drop in platelet count. Therefore, a patient with coinfection may experience compounded symptoms, making it feel like a battle against two illnesses at once. When coinfection is suspected, careful monitoring of platelet levels and symptomatic treatment is key," she said.
Dr Golwilkar-Mehendale said PCR tests can be deployed to check if coinfection is present in a patient.
"In rare cases, detection of both chikungunya and dengue antibodies in the same patient may be due to cross-reactivity rather than coinfection, as the body's immune system may have produced antibodies in response to previous exposures. Cross-reactivity between antibodies can sometimes lead to confusion in diagnosing coinfections. To resolve such cases, a PCR test can help confirm the presence of active infections of both viruses," she said.
Dr Ameet Dravid, an infectious disease expert from Noble Hospital, said: "Coinfections involving chikungunya, dengue, zika and even salmonella have been observed, though they are not necessarily more severe than a single predominant infection. In cases of coinfection, one virus typically dominates, causing the majority of complications."
However, Dr Dravid said there have been cases in which a coinfection led to serious outcomes. "We had a patient with both chikungunya and salmonella infection, which led to complications such as encephalitis, requiring the patient to be placed on a ventilator. This highlights the fact that while coinfections may not always increase overall severity, they can complicate the clinical picture, especially if the predominant infection is particularly aggressive," he said.
Dr Devashish Desai, consultant of infectious diseases at Ruby Hall Clinic, said: " This year, I have personally seen only two patients with coinfection, but such cases are likely to be more widespread. There have even been cases of patients infected with dengue, chikungunya and zika all simultaneously, as all three are spread by the same mosquito."
Dr Desai said in terms of symptoms, patients are often first identified as having dengue fever, due to its rather distinct effects such as high fever and a drop in platelets. "But when people experience joint pain, beyond the usual body ache and red eyes, we also test for chikungunya. A positive test for chikungunya confirms a coinfection of both dengue and chikungunya."
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