European Journal of Cardiovascular Medicine

Aim: To describe the presentation and outcome of secondary Methicillin-resistant Staphylococcal aureus (MRSA) infections in a cohort of confirmed dengue fever patients over a 5-year period, a rare but severe complication.  Methods: There were 18 patients with culture-confirmed Methicillin Resistant Staphylococcal infection of the 1170 patients admitted with Dengue fever over five years at Calicut Medical College, Kerala. Their mode of presentation, complications and outcome were studied.   Results: The Average age of the subjects were 45.8 years (range 22 -71 years) and the male-female ratio was 3:2. Most patients with MRSA complicating Dengue fever had a relapse of fever after 11-18 afebrile days (78%). Four patients had continued fever for more than one week, which is unusual for uncomplicated Dengue fever. Mortality in MRSA patients was 22% (4/18). The site of MRSA infection was most often skin and soft tissue, followed by lungs. Characteristic laboratory markers of leukocytosis following initial leucopenia and raised Erythrocyte sedimentation rate (ESR) were seen in all patients. Conclusions: MRSA secondary infection in Dengue fever occurred in 1.5% of the cohort and carried a mortality of 22%. It usually manifests about one week after the initial onset of fever with varying manifestations dependent on the infection site. Leukocytosis and raised ESR occurred in all patients. Preventing MRSA in patients admitted with dengue is of utmost importance. Early detection and treatment are essential for a better outcome.