Is dengue and malaria co-infection more severe than single infections? A retrospective matched-pair study in French Guiana

Epelboin, Loïc; Hanf, Matthieu; Dussart, Philippe; Ouar-Epelboin, Sihem; Djossou, Félix; Nacher, Mathieu; Carme, Bernard

doi:10.1186/1475-2875-11-142

Table 3 Matched bivariate analysis between co-infected patients and pure dengue infected patients

From: Is dengue and malaria co-infection more severe than single infections? A retrospective matched-pair study in French Guiana

Results n (%)	Co-infection (n = 104) N (%)	Dengue (n = 208) N (%)	p*
Males	75 (72.1)	119 (57.2)	0.01^§
Children (<15 years-old)	11 (10.6)	49 (23.6)	0.008^§
Journey in forest	26 (25)	7 (3.4)	<0.001^§
Living on the coast ^¥	86 (83.5)	183 (92.9)	0.025^§
Long admission (≥2 days)	43 (41.3)	71 (34.1)	0.23
Admission	37 (35.6)	45 (21.6)	0.01^§
Medical history of malaria	52 (50)	21 (10.2)	<0.001^§
Time since last malaria attack < 90 days	15 (44.1)	0 (0)	-
Medical history of dengue	3 (3.4)	5 (2.7)	0.64
Duration of fever > 5 days	48 (48.5)	33 (16.3)	<0.001^§
Red cells transfusion	8 (7.7)	2 (1)	0.03^§
Tachycardia (>90 bpm)	79 (79)	128 (64.6)	0.03^§
Hypotension (<90 mmHg)	10 (10.4)	3 (1.8)	0.02^§
Fever ≥ 40°C	15 (14.7)	10 (4.9)	0.006^§
Retro-orbital pain	4 (3.9)	26 (12.6)	0.01^§
Chills	36 (35.6)	37 (18)	0.002^§
Hemorrhagic signs ^†	12 (11.5)	32 (15.5)	0.31
Shock signs ^‡	7 (6.8)	5 (2.4)	0.06^§§
Rash	1 (1)	30 (14.6)	0.007^§
Neurological disorders	7 (6.8)	8 (3.9)	0.28
Nausea and / or vomiting	58 (56.9)	94 (45.6)	0.07^§§
Dehydration	7 (7.4)	4 (1.9)	0.04^§
Mucocutaneous pallor	11 (11.6)	3 (1.5)	0.003^§
Splenomegaly	9 (12.3)	3 (3.1)	0.04^§
Jaundice	9 (8.7)	6 (2.9)	0.03^§
ENT symptoms	6 (5.8)	42 (20.2)	0.002^§
Severe “malaria” cases ^††	34 (32,7)	33 (15,9)	<0,001
Confirmed acute dengue cases	41 (39.4)	150 (72.1)	<0.001^§
Mildly low hemoglobin (<12 g/dl)	37 (35.6)	40 (19.2)	0.002^§
Low hematocrit (<36%)	43 (41.3)	34 (16.4)	<0.001^§
Deep thrombocytopenia (<50 G/L)	23 (22.1)	6 (2.9)	<0.001^§
Low prothrombin (<70%)	14 (21.2)	19 (13.9)	0.18^§§
Hyponatremia (<130)	7 (7.1)	5 (2.5)	0.08^§§
Hypokalemia (<3)	6 (6.1)	3 (1.5)	0.04^§
Elevated creatinin (>111 μmol/L)	4 (4)	4 (2)	0.3
Elevated bilirubin (>50 μmol/L)	16 (16.8)	3 (1.6)	<0.001^§
SGPT (>2 N)	10 (10.2)	32 (16)	0.2
SGOT >2 N	13 (13.3)	41 (20.5)	0.16^§§
CRP <5	2 (2)	73 (35.3)	<0.001^§
CRP 5 à 50	29 (29)	115 (55.6)	-
CRP > 50	69 (69)	19 (9.2)	-

* p calculated with Wald test in matched bivariate analysis.
^§ Significant p-values < 0.05.
^§§p-values < 0.2 included in the matched multivariate model
bpm Beats per minute..
^¥ People living on the coast are defined as people living in Cayenne, Rémire-Montjoly, Matoury Macouria, Kourou, Irakoubo or Mana. ; Other people declared to live in Cacao, Roura, Montsinnéry-Tonnégrande, Régina, Saül, St-Elie, Saint Laurent du Maroni, Apatou, Maripasoula, Papaïchton, St George de l’Oyapock, Camopi or Trois-Sauts. 4 people came from France, 1 from the French Caribbean and 1 from French Polynesia.
^†Hemorrhagic signs included purpura, gingival bleeding, epistaxis, macroscopic hematuria, hematemesis, melena, rectal bleeding and hemoptysis.
^‡Signs of shock included systolic blood pressure <90 mmHg or not responding to IV fluids and with or without oliguria. ENT symptoms included diagnoses of rhinitis, nasopharyngitis, pharyngitis, sinusitis and otitis.
^†† WHO 2000 criteria for severe P. falciparum malaria [20].
ENT Ear, Nose and Throat, SGPT Serum Glutamopyruvate Transferase, SGOT Serum Glutamooxaloacetate Transférase, CRP C-reactive protein.

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