Cluster of Staphylococcus aureus and Dengue Co-infection in Singapore

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 antistaphylococcal 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.