Cluster of Staphylococcus aureus and dengue co-infection in Singapore

Abstract

Introduction: Singapore saw a resurgence of dengue infections in 2005. Concurrent bacterial co-infections in dengue is rare. Clinical Picture: We report a cluster of serious methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia or severe soft tissue infection in 5 epidemiologically linked construction workers presenting with dengue and non-resolving fever. Treatment: Surgical intervention was indicated in 4 of the 5 patients despite appropriate anti-staphylococcal therapy. Outcome: All but 1 patient were eventually discharged. Clonality and Panton-Valentine leucocidin genes were not demonstrated. Epidemiological investigations suggested that occupational contact dermatitis could have predisposed the patients to this opportunistic co-infection. Conclusion: Clinicians need to be vigilant to unusual manifestations of dengue which may signal a concomitant aetiology.