{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:12:11Z","timestamp":1770905531546,"version":"3.50.1"},"reference-count":48,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: In tropical regions, dengue and leptospirosis coexist and share a nonspecific clinical onset that hinders timely diagnosis. Coinfection may worsen the clinical course and increase mortality. Objective: To estimate the prevalence of dengue, leptospirosis, and coinfection among patients with febrile syndrome in Madre de Dios (Peru) and to identify associated clinical factors. Methods: Observational, analytical, cross-sectional, retrospective study conducted at a primary-level health facility. Clinical and laboratory records of patients with febrile syndrome seen in 2024 were analyzed. Categorical variables were summarized as frequencies (%) and numeric variables as mean \u00b1 SD or median [IQR]. Comparisons used chi-square or Fisher\u2019s exact test, Student\u2019s t test, or the Mann\u2013Whitney U test, as appropriate. Associations were estimated using Poisson regression models with robust variance, adjusted for sex, reporting prevalence ratios (PRs) and 95% CIs. Analyses were performed in R 4.0.2. Results: A total of 226 patients were included. Positivity was 19.0% for dengue (43\/226), 66.8% for leptospirosis (151\/226), and 5.8% for coinfection (13\/226). In the bivariate analysis, dengue was associated with higher temperature (p &lt; 0.001), lower mean arterial pressure (p = 0.007), mucosal bleeding\/ecchymosis (p = 0.049), and lower fluid intake (p = 0.021); temperature was also higher in coinfection (p = 0.021). In Poisson models, dengue was associated with tachycardia (PR = 5.69; 95% CI: 1.95\u201313.07; p &lt; 0.001), temperature (PR = 1.61 per \u00b0C; 1.23\u20132.12; p = 0.001), bilateral polyarthralgia (PR = 2.55; 1.14\u20135.04; p = 0.012), and mucosal bleeding\/ecchymosis (PR = 3.31; 0.94\u20138.37; p = 0.027). Leptospirosis was associated with male sex (PR = 0.78 vs. female; 0.65\u20130.94; p = 0.010) and fever (PR = 2.38; 1.17\u20136.03; p = 0.035). Leptospira\u2013dengue coinfection was related to higher temperature (PR = 1.75 per \u00b0C; 1.05\u20133.01; p = 0.036). Conclusions: Simple clinical signs such as fever\/elevated temperature, tachycardia, bilateral polyarthralgia, and mucosal bleeding can help prioritize suspicion of dengue, leptospirosis, or coinfection; guide requests for dual testing (dengue\u2013Leptospira), early hydration in dengue, and timely initiation of antibiotic therapy in leptospirosis. These findings support the development of integrated triage algorithms and strengthening access to molecular diagnostics in high-burden febrile syndrome settings.<\/jats:p>","DOI":"10.3390\/tropicalmed11020050","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:05:46Z","timestamp":1770897946000},"page":"50","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with the Prevalence of Dengue\u2013Leptospirosis Coinfection in Patients Hospitalized for Febrile Syndrome"],"prefix":"10.3390","volume":"11","author":[{"given":"Dina I.","family":"Bance-Anicama","sequence":"first","affiliation":[{"name":"Unidad de Salud P\u00fablica, Escuela de Posgrado, Universidad Peruana Uni\u00f3n, Lima 15072, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda M.","family":"Diaz-Orihuela","sequence":"additional","affiliation":[{"name":"Unidad de Salud P\u00fablica, Escuela de Posgrado, Universidad Peruana Uni\u00f3n, Lima 15072, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luz M.","family":"Diaz-Orihuela","sequence":"additional","affiliation":[{"name":"Unidad de Salud P\u00fablica, Escuela de Posgrado, Universidad Peruana Uni\u00f3n, Lima 15072, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1208-9121","authenticated-orcid":false,"given":"Wilter C.","family":"Morales-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Direcci\u00f3n General de Investigaci\u00f3n e Innovaci\u00f3n, Universidad Peruana Uni\u00f3n, Lima 15072, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref_1","first-page":"6637","article-title":"Dengue y Leptospira: Fisiopatolog\u00eda y Coincidencias Cl\u00ednicas","volume":"8","year":"2024","journal-title":"Cienc. Lat. Rev. Cient\u00edfica Multidiscip."},{"key":"ref_2","unstructured":"World Health Organization (2023). Dengue\u2014Global Situation (Disease Outbreak News No. 2023-DON498)."},{"key":"ref_3","first-page":"e81","article-title":"Leptospirosis in Latin America: Exploring the first set of regional data","volume":"41","author":"Schneider","year":"2017","journal-title":"Rev. Panam. De Salud Publica Pan Am. J. Public Health"},{"key":"ref_4","unstructured":"Centro Nacional de Epidemiolog\u00eda (2025, September 15). N\u00famero de Casos de Leptospirosis, Per\u00fa 2019\u20132024. Available online: https:\/\/www.dge.gob.pe\/portal\/docs\/vigilancia\/sala\/2024\/SE45\/leptospirosis.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"438","DOI":"10.25176\/RFMH.v21i2.3459","article-title":"Dengue with signs of alarm and leptospirosis in a pediatric patient with COVID-19","volume":"21","author":"Gomez","year":"2021","journal-title":"Rev. De La Fac. De Med. Humana"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100698","DOI":"10.1016\/j.ijmmb.2024.100698","article-title":"Epidemiological analysis of leptospirosis, dengue, and Co-infection rates among febrile illness cases in Dakshina Kannada, Karnataka","volume":"51","author":"Veena","year":"2024","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Boey, K., Shiokawa, K., and Rajeev, S. (2019). Leptospira infection in rats: A literature review of global prevalence and distribution. PLoS Neglected Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007499"},{"key":"ref_8","unstructured":"Centro Para el Control y la Prevenci\u00f3n de Enfermedades de Estados Unidos (2025, August 20). Centros Para el Control y la Prevenci\u00f3n de Enfermedades (CDC): Proteger a la Poblaci\u00f3n de las Amenazas Para la Salud. Available online: https:\/\/www.paho.org\/es\/alianzas\/centros-para-control-prevencion-enfermedades-cdc-proteger-poblacion-amenazas-para-salud."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Costa, F., E Hagan, J., Calcagno, J., Kane, M., Torgerson, P., Martinez-Silveira, M.S., Stein, C., Abela-Ridder, B., and I Ko, A. (2015). Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Neglected Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003898"},{"key":"ref_10","unstructured":"Organizaci\u00f3n Panamericana de la Salud (2026, January 18). Estrategia de Gesti\u00f3n Integrada Para la Prevenci\u00f3n y el Control del Dengue. Available online: https:\/\/www.paho.org\/es\/temas\/dengue\/estrategia-gestion-integrada-para-prevencion-control-dengue."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"397","DOI":"10.4269\/ajtmh.20-0656","article-title":"Leptospirosis among Dengue-Negative Febrile Patients in Selangor, Malaysia","volume":"107","author":"Loong","year":"2022","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e20200118","DOI":"10.1590\/1678-9199-jvatitd-2020-0118","article-title":"Leptospirosis diagnosis among patients suspected of dengue fever in Brazil","volume":"27","author":"Fornazari","year":"2021","journal-title":"J. Venom. Anim. Toxins Incl. Trop. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1186\/s13256-024-04675-0","article-title":"Dengue and leptospirosis coinfection: A case series","volume":"18","author":"Asaduzzaman","year":"2024","journal-title":"J. Med. Case Rep."},{"key":"ref_14","first-page":"e61863","article-title":"Concurrently Affected by Dengue and Hepatitis A: Exploring the Intricacies of Co-infection in a Comprehensive Case Series","volume":"16","author":"Vagha","year":"2024","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/10937404.2019.1654422","article-title":"Environmental health effects attributed to toxic and infectious agents following hurricanes, cyclones, flash floods and major hydrometeorological events","volume":"22","author":"Erickson","year":"2019","journal-title":"J. Toxicol. Environ. Health Part B Crit. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13071-018-2643-9","article-title":"Natural vertical transmission of dengue virus in Aedes aegypti and Aedes albopictus: A systematic review","volume":"11","year":"2018","journal-title":"Parasites Vectors"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"311","DOI":"10.3201\/eid2602.190102","article-title":"Influence of rainfall on leptospira infection and disease in a tropical urban setting, Brazil","volume":"26","author":"Hacker","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"12","DOI":"10.71164\/socialmedicine.v16i1.2023.1519","article-title":"Differences in the association of dengue and leptospirosis incidences with respect to socio-sanitary vulnerability in the city of Santa Fe, Argentina","volume":"16","author":"Avalos","year":"2023","journal-title":"Soc. Med."},{"key":"ref_19","first-page":"78","article-title":"Leptospirosis anict\u00e9rica en un brote epi\u00e9mico de dengue en la Pen\u00ednsula de Yucat\u00e1n","volume":"9","year":"1998","journal-title":"Rev. Biomed."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"766","DOI":"10.3201\/eid1105.041212","article-title":"Leptospirosis during dengue outbreak, Bangladesh","volume":"11","author":"LaRocque","year":"2005","journal-title":"Emerg. Infect. Dis."},{"key":"ref_21","first-page":"92","article-title":"Leptospirosis in suspected cases of dengue in Jamaica, 2002\u20132007","volume":"40","author":"Brown","year":"2010","journal-title":"Trop. Dr."},{"key":"ref_22","first-page":"35","article-title":"Dengue and leptospirosis share the same ecological niche in Carmen del Paran\u00e1 (Itapua), a riverside locality","volume":"8","author":"Cabello","year":"2010","journal-title":"Mem. Inst. Investig. Cienc. Salud"},{"key":"ref_23","first-page":"97","article-title":"Leptospirosis and dengue co-infection in a Brazilian Amazon patient","volume":"1","author":"Crociati","year":"2010","journal-title":"Rev. Panamazonica Saude"},{"key":"ref_24","first-page":"519701","article-title":"Leptospirosis prevalence in patients with initial diagnosis of dengue","volume":"2012","author":"Elizabeth","year":"2012","journal-title":"J. Trop. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12929-017-0344-x","article-title":"Clinical predictors of dengue fever co-infected with leptospirosis among patients admitted for dengue fever\u2014A pilot study","volume":"24","author":"Suppiah","year":"2017","journal-title":"J. Biomed. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jmii.2013.03.001","article-title":"Laboratory diagnosis of leptospirosis: A challenge","volume":"46","author":"Musso","year":"2013","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"590","DOI":"10.4269\/ajtmh.17-0734","article-title":"Epidemiology of human leptospirosis in French Guiana (2007\u20132014): A retrospective study","volume":"99","author":"Mosnier","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1093\/trstmh\/tru144","article-title":"Predictors of mortality in leptospirosis: An observational study from two hospitals in Kolkata, eastern India","volume":"108","author":"Goswami","year":"2014","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"179","DOI":"10.17843\/rpmesp.2015.321.1591","article-title":"Coinfecci\u00f3n por dengue y leptospirosis en una ni\u00f1a de la Amazon\u00eda Peruana","volume":"32","year":"2015","journal-title":"Rev. Peru Med. Exp. Salud Publica"},{"key":"ref_30","first-page":"127","article-title":"Leptospirosis in present environment","volume":"39","author":"Palacios","year":"2014","journal-title":"Rev. Electr\u00f3nica"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1017\/S0950268814003707","article-title":"Concomitant leptospirosis-hantavirus co-infection in acute patients hospitalized in Sri Lanka: Implications for a potentially worldwide underestimated problem","volume":"143","author":"Clement","year":"2015","journal-title":"Epidemiol. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1007\/s11468-023-02113-3","article-title":"Detection of Plasma, Platelets, Hemoglobin in Blood Sample of Dengue Malaria Based on Surface Plasmon Resonance Biosensor Using Black Phosphorus: A Numerical Analysis","volume":"19","author":"Kumar","year":"2024","journal-title":"Plasmonics"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"del Valle-Mendoza, J., Palomares-Reyes, C., Carrillo-Ng, H., Tarazona-Castro, Y., Kym, S., Aguilar-Luis, M.A., del Valle, L.J., Aquino-Ortega, R., Martins-Luna, J., and Pe\u00f1a-Tuesta, I. (2021). Leptospirosis in febrile patients with suspected diagnosis of dengue fever. BMC Res. Notes, 14.","DOI":"10.1186\/s13104-021-05627-3"},{"key":"ref_34","unstructured":"Vargas, F. (2024). S\u00edndrome Febril y los Casos Confirmados de Dengue en el Hospital Santa Rosa de Madre de Dios Durante el Periodo Noviembre 2021 a Abril 2022. [Bachelo\u2019s Thesis, Universidad Nacional Amaz\u00f3nica de Madre de Dios]."},{"key":"ref_35","unstructured":"Presidencia de la Rep\u00fablica del Per\u00fa (2024). Decreto Supremo N.\u00b0 005-2024-SA (Normas Legales N.\u00b0 31427), Diario Oficial El Peruano."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"805","DOI":"10.56048\/MQR20225.7.1.2023.805-827","article-title":"Infecciones Vectoriales: Manifestaciones Cl\u00ednicas Y Diagn\u00f3stico Diferencial","volume":"7","year":"2023","journal-title":"MQRInvestigar"},{"key":"ref_37","unstructured":"Argimon, J.M. (2019). Metodos de Investigaci\u00f3n Clinica y Epidemiologica, Elsevier Espa\u00f1a, S.A.U."},{"key":"ref_38","unstructured":"(2026, January 18). Norma T\u00e9cnica de Salud Para la Atenci\u00f3n Integral de Pacientes con Dengue en el Per\u00fa. NTS N\u00b0211-MINSA\/DGIESP. Available online: https:\/\/cdn.www.gob.pe\/uploads\/document\/file\/6007546\/5323501-r-m-175-2024-minsa-y-nts-211-dgiesp.pdf?v=1709834791."},{"key":"ref_39","first-page":"80","article-title":"Prevalencia de Leptospirosis y factores de riesgo en personas con antecedentes de fiebre en la Provincia de Manu, Madre de Dios, Per\u00fa","volume":"20","author":"Ormaeche","year":"2003","journal-title":"Rev. Peru Med. Exp. Salud Publica"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"530","DOI":"10.4067\/S0716-10182015000600006","article-title":"Frecuencia de leptospirosis y caracter\u00edsticas socio-demogr\u00e1ficas en pacientes febriles del norte del Per\u00fa","volume":"32","year":"2015","journal-title":"Rev. Chil. De Infectol."},{"key":"ref_41","first-page":"195","article-title":"Seroprevalencia de leptospirosis y caracter\u00edsticas sociadas en agricultores de arroz de una regi\u00f3n tropical del Per\u00fa","volume":"31","author":"Tejada","year":"2014","journal-title":"Rev. Peru Med. Exp. Salud Publica"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e394","DOI":"10.1016\/j.ijid.2012.12.012","article-title":"A hospital-based study on seroprevalence of leptospirosis among febrile cases in northeastern Malaysia","volume":"17","author":"Rafizah","year":"2013","journal-title":"Int. J. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"155","DOI":"10.18683\/germs.2021.1253","article-title":"Seropositivity for dengue and leptospira igm among patients with acute febrile illness: An indicator of co-infection?","volume":"11","author":"Dhanashree","year":"2021","journal-title":"Germs"},{"key":"ref_44","first-page":"66","article-title":"Dengue: News and standards in clinical approach","volume":"21","year":"2021","journal-title":"Acta Colomb. De Cuid. Intensivo"},{"key":"ref_45","first-page":"240","article-title":"Factores asociados a dengue grave en pacientes del departamento del Cauca-Colombia 2015\u20132021","volume":"38","year":"2025","journal-title":"Iatreia"},{"key":"ref_46","unstructured":"Guevara, K., L\u00f3pez, M., Marroqu\u00edn, J., Sotz, J., and Tello del Valle, E. (2025). Incidencia y Caracterizaci\u00f3n Epidemiol\u00f3gica del Dengue en la Poblaci\u00f3n en General que Acude al Hospital IGSS de Huehuetenango, Ubicado en el Departamento de Huehuetenango, Durante el Per\u00edodo de Julio a Diciembre 2024. [PhD. Thesis, Universidad Galileo DSpace]."},{"key":"ref_47","first-page":"e2409","article-title":"Clinical characteristics and epidemiological situation of dengue fever in Peru: A systematic review","volume":"17","author":"Negreiros","year":"2024","journal-title":"Rev. Del Cuerpo Med. Hosp. Nac. Almanzor Aguinaga Asenjo"},{"key":"ref_48","unstructured":"Valdivia, D. (2021). Nivel de Asociaci\u00f3n Entre Trombocitopenia y las Manifestaciones Cl\u00ednicas del Dengue en Pacientes Atendidos en un Hospital II-I en la Ciudad de Ica Entre Enero del 2018 y Junio del 2020. [Bachelor\u2019s Thesis, Universidad Nacional San Luis Gonzaga]."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/2\/50\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T13:20:17Z","timestamp":1770902417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/2\/50"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":48,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["tropicalmed11020050"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed11020050","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]}}}