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.
In recent years, Singapore has seen a resurgence of dengue fever despite the seemingly successful implementation of a nationwide Aedes mosquito control programme,1 culminating in 9459 clinical and laboratory-confirmed dengue cases in 2004 and up to 13,653 cases in its 2005 dengue epidemic.2
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