Evidence of Overlapping Infections of Dengue, Malaria and Typhoid in Febrile Patients Attending a Tertiary Health Facility in Uyo, South-South Nigeria

Background: Malaria, typhoid, and dengue have become significant diseases worldwide, especially in Africa due to their increasing endemicity. Similarities in signs and symptoms in infected individuals make it difficult for healthcare providers to clinically diagnose these diseases in patients presenting with feverish conditions in the clinics.

Aim: This study aimed to determine the prevalence of malaria, typhoid/paratyphoid and dengue in patients with febrile conditions attending University of Uyo Teaching Hospital, Uyo-Nigeria.

Study Design: This was a cross sectional study of patients with febrile conditions.

Place and Duration of Study: The study was conducted at the University of Uyo Teaching Hospital, Uyo-Nigeria from May - August, 2014.

Methodology: A total of 145 febrile patients were investigated for malaria, typhoid/paratyphoid and dengue using thick Giemsa staining technique, microtitre plate (single antibody titre) quantitative assay (Antibody titre ≥160), and dengue NS1 Ag/IgM/IgG serology, respectively.

Results: Of the 145 patients, 51(35.2%), 10(7.0%) and 7(4.8%) had malaria, typhoid/paratyphoid and dengue, respectively. A total of 20(37.0%) males and 31(34.1%) females had malaria, while 3(2.1%) males and 7(4.8%) females had typhoid. Dengue viral markers were detected in 1(1.9%) male and 3(3.2%) females. The age range of patients in this study was <1-70 years, with mean (±SD) age of 34.1±12.7 years. The highest infected age groups were 61-70 yr, 3(60.0%) for malaria; 41-50 yrs, 3(23.1%) each for typhoid/paratyphoid and dengue, respectively. A significant association existed between age of patients and malaria and not with typhoid and dengue diseases. A total of 2(21.4%) patients had malaria/typhoid/paratyphoid co-infection, while 1(10.7%) had malaria/dengue co-infection. Dengue patients with active disease tested positive with NS1 antigen, 4(2.8%) and specific-IgM antibodies, 2(1.4%).

Conclusion: This study concludes that dengue virus as well as malaria parasite and S. Typhi/ S. paratyphi are among the aetiologic microbial agents of fever in this locality. Hence, differential diagnosis of patients with feverish conditions should not only be limited to malaria and typhoid as is always the case in our hospitals. These findings have raised serious public health concern as outbreaks of dengue may occur unnoticed if suspicion index is not raised among health care practitioners.