“MORE THAN IT MEETS THE EYE” – AN ATYPICAL CASE OF DENGUE AND ENTERIC FEVER COINFECTION COMPLICATED BY PULMONARY EMBOLISM

Abstract

At a time when infectious diseases , bacterial , viral and fungal are yielding to stratagems such as immunization and antimicrobial agents, dengue fever continues to pose major clinical , social and epidemiological challenges both in India and Worldwide. Dengue is a mosquito born viral disease by the vector Aedes aegyptii or Aedes albopictus during the taking of a blood meal. Dengue infection can be either asymptomatic, or progress to involve haemorrhagic manifestations with shock.[5] Enteric fever is a systemic disease characterized by fever and abdominal pain caused by dissemination of Salmonella typhi or paratyphi A, B or C. Fever is documented at presentation in more than 75% cases and typically prolonged and continuing up to 4weeks if untreated. Here we present an Atypical case of Dengue and Enteric fever coinfection in a young male where the unusual and ever changing clinical manifestation posed a nerve wrecking challenge in the management of this case. Thrombotic events have not been extensively reported, despite the wide range of increased procoagulant activity during illness.[6,7] And the peculiarity in this case was the severe dehydration Leading to a thrombophilic state which led to the dichotomy of whether to use Anticoagulants in the phase of severe dengue fever leading to very low platelet count which predisposes to spontaneous bleeding.