A rare case of dengue and H1N1 co-infection: A deadly duo

Addressing the Dual Threat of Dengue and Influenza in Bangladesh: A Perspective on the Prevention and Preparedness Strategies

Background and Aim

In Bangladesh, dengue fever and influenza pose serious public health risks due to their high rates of morbidity and fatality. Frequent outbreaks have been caused by dengue, a virus spread by mosquitoes that causes flu-like symptoms, particularly during the monsoon season. Another infectious respiratory illness that varies every year is influenza. Both illnesses frequently co-circulate in tropical areas like Bangladesh, raising the possibility of co-infection and putting vulnerable groups at higher risk. The purpose of the article is to explore the effects of dengue and influenza co-infection in Bangladesh, looking at present issues and possible solutions to this dual health burden.

Methodology

This perspective piece gathers data from authoritative sources, including PubMed, the World Health Organization, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh, and the European Center for Disease Prevention and Control. Relevant literature on dengue and influenza incidence, control measures, and co-infection dynamics was reviewed.

Discussion

In Bangladesh, dengue incidence are still on the rise, while influenza infections have climbed, especially during the winter. The country's healthcare system may be overburdened by the simultaneous spread of both diseases, particularly if dengue rates keep rising and influenza cases rise. To lessen the effects of these illnesses, effective community awareness campaigns, vector control initiatives, and early diagnosis techniques are crucial.

Conclusion

Bangladesh must emphasize increased preventative and preparation measures, such as better monitoring, public health communication, and vaccine development research, given the twin danger posed by dengue and influenza. To lower the likelihood of co-infection and avert future public health emergencies, coordinated actions are essential.

Influenza and dengue virus co-infection impairs monocyte recruitment to the lung, increases dengue virus titers, and exacerbates pneumonia

Co-infections of influenza virus and bacteria are known to cause severe disease, but little information exists on co-infections with other acute viruses. Seasonal influenza and dengue viruses (DENV) regularly co-circulate in tropical regions. The pandemic spread of influenza virus H1N1 (hereafter H1N1) in 2009 led to additional severe disease cases that were co-infected with DENV. Here, we investigated the impact of co-infection on immune responses and pathogenesis in a new mouse model. Co-infection of otherwise sublethal doses of a Nicaraguan clinical H1N1 isolate and two days later with a virulent DENV2 strain increased systemic DENV titers and caused 90% lethality. Lungs of co-infected mice carried both viruses, developed severe pneumonia, and expressed a unique pattern of host mRNAs, resembling only partial responses against infection with either virus alone. A large number of monocytes were recruited to DENV-infected but not to co-infected lungs, and depletion and adoptive transfer experiments revealed a beneficial role of monocytes. Our study shows that co-infection with influenza and DENV impairs host responses, which fail to control DENV titers and instead, induce severe lung damage. Further, our findings identify key inflammatory pathways and monocyte function as targets for future therapies that may limit immunopathology in co-infected patients.

Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases

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.