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Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases
Perdigão, Anne Carolinne Bezerra; Ramalho, Izabel Letícia Cavalcante; Guedes, Maria Izabel Florindo; Braga, Deborah Nunes Melo; Cavalcanti, Luciano Pamplona Góes; Melo, Maria Elisabeth Lisboa de; Araújo, Rafael Montenegro de Carvalho; Lima, Elza Gadelha; Silva, Luciene Alexandre Bié da; Araújo, Lia de Carvalho & Araújo, Fernanda Montenegro de Carvalho
Abstract
We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy
and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and
all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be
considered in locations where these two viruses’ epidemic periods coincide to avoid fatal outcomes. Dengue is a
mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable
of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As
a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with
that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza
A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout
the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first
laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in
Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since
2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The
influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed
coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and
influenza season in 2012 and 2013 in Ceará.
Keywords
dengue; fatal case; influenza A(H1N1)pdm09
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