26.MANINDER PAL SINGH PARDAL.cdr INTRODUCTION In September 2019 , the workers came across a large number of fever cases in a mid sized city of India. Detailed epidemiological investigations revealed that there was an outbreak of 28 cases of Enteric fever and 17 cases of Dengue fever. In this paper, we describe ve cases in these two outbreaks who had Dengue fever and Enteric fever co- infection. MATERIAL AND METHODS The study design used was a cross sectional descriptive study. Period of the study was Sep 2019 in a mid sized city of India. Detailed information pertaining to date of onset of symptoms, date of admission, movement history during the known incubation period, history of having worked as food handler in the cook house, personal hygiene and other relevant data was obtained from each case. Besides, active case nding by way surveys during the period of the outbreak was also carried out. The study team reviewed thoroughly all the cases which occurred during the period of study. A detailed clinical and epidemiological history was elicited. Case denition used for conrmed case of Enteric fever by the workers has already 1been validated by Pardal MPS et al. Case denition for conrmed case of Dengue fever has also been validated by 2Kunwar R et al. RESULTS All the ve cases which occurred during the period of study were conrmed by blood culture for salmonella typhi and NS1 Antigen for dengue fever. All the cases had clinical features of Enteric fever viz, moderate to high grade fever, relative bradycardia, pain abdomen, loose motions, headache and cough. However, rose spots were observed only in 2 (40%) cases. All the cases also displayed clinical features of Dengue fever, viz muscle and joint pain; and 3 (60%) of them had vomiting in addition to the above features of Enteric fever. There was no leucopenia or relative lymphocytosis in any case. The organism was conrmed on blood culture as S enterica serovar Typhi (S typhi) in all the ve cases. The antibiotic sensitivity test revealed resistance against ampicillin, chloramphenicol, and cotrimoxazole. The patients did not show good clinical response to ciprooxacin, while the best clinical response was obtained with ceftazidime. There were no complications or fatalities in any of these cases. DISCUSSION Enteric fever and dengue fever have been major cause of morbidity and mortality all over the world. is a major cause of 3,4,5,6morbidity and mortality in tropical areas worldwide. Sudjana P et al reported a case of Dengue and typhoid fever 7co-infection in an adult in Indonesia. Bansal R et al reported 8two cases of Dengue fever and typhoid co-infection in 2015. Sharma Y et al reported eleven cases of typhoid co-infection out of 141 cases of dengue, giving a coinfection rate of 7.8% in 9North Delhi. Srinivasaraghavan R et al reported a case of culture positive Salmonella typhi in a ten year old child with 10dengue fever. In our study we have reported ve cases of culture positive Salmonella typhi out of seventeen cases of dengue fever, thereby giving a co-infection rate of 29.41% 9which is much higher than that carried out by Sharma Y et al. Besides, this is one of the rare instances wherein, ve cases of dengue and typhoid fever are being reported, as against other 7,8,10workers who have reported one or two such cases. RECOMMENDATIONS In day to day clinical practice, while dealing with cases of dengue either typical or atypical, co-infection with enteric fever should always be kept in mind. Besides improvement of sanitation and personal hygiene, emphasis should be given on vaccination against typhoid. In order to reduce the burden of dengue fever, all strictest possible preventive measures to control the breeding of Aedes mosquito must be implemented. CONCLUSION: The workers wish to emphasize that the risk factors predicting the presence of such co-infections, if identied, will certainly go a long way in controlling the incidence of dengue and typhoid co-infection. CONFLICTS OF INTEREST None identied REFERENCES 1. Pardal MPS, Minhas S. Outbreak of enteric fever: a fact nding mission. Int J Community Med Public Health 2020;7:998-1002 2. Kunwar R, Prakash R. Dengue outbreak in a large military station : Have we learnt any lesson? Medical Journal Armed Forces India 2015 (71),11-14. 3. Divyashree S, Nabarro LE, Veeraraghavan B, Rupali P. Enteric fever in India: current scenario and future directions. Trop Med Int Health. 2016 Oct;21(10):1255-1262. doi: 10.1111/tmi.12762. Epub 2016 Sep 8. 4. Vanderslott S, Phillips MT, Pitzer VE, Kirchhelle C. Water and Filth: Reevaluating the First Era of Sanitary Typhoid Intervention (1840-1940). Clin Infect Dis. 2019 Oct 15;69(Supplement_5):S377-S384. doi: 10.1093/cid/ciz610. 5. Mustafa MS, Rastogi V, Jain S, Gupta V. Discovery of fth serotype of dengue virus (DENV-5): A new public health dilemma in dengue control. Medical Jou DENGUE AND ENTERIC FEVER CO-INFECTION : A KNOWN ENTITY? Original Research Paper Dr PMP Singh DADH, HQ 41 Artillery Division, C/0 56 APO X 15GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Community Medicine INTRODUCTION : In this paper, we describe ve cases of Dengue fever and Enteric fever co-infection. MATERIAL AND METHODS : The study design used was a cross sectional descriptive study. RESULTS : All the ve cases which occurred during the period of study were conrmed by blood culture for salmonella typhi and NS1 Antigen for dengue fever. There were no complications or fatalities. DISCUSSION : Co-infection with Dengue and Enteric fever has been reported by several workers in India as well as abroad. In our study we have reported ve cases of culture positive Salmonella typhi out of eleven cases of dengue fever. RECOMMENDATIONS : While dealing with cases of dengue, co-infection with enteric fever should always be kept in mind. CONCLUSION: The workers emphasize that the risk factors predicting the presence of such co-infections, if identied, will certainly go a long way in controlling the incidence of dengue and typhoid co-infection. ABSTRACT KEYWORDS : VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr Sukhmeet Minhas* Ofcer Commanding, Station Health Organisation, Kirkee *Corresponding Author 16 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS rnal Armed Forces India 2015 (71),67-70. 6. Chumpu R, Khamsemanan N, Nattee C. The association between dengue incidences and provincial-level weather variables in Thailand from 2001 to 2014. PLoS One. 2019 Dec 26;14(12):e0226945. doi: 10.1371/journa l.pon e.02 26945. eCollection 2019. 7. Sudjana P, Jusuf H. Concurrent dengue hemorrhagic fever and typhoid fever infection in adult: Case report. Southeast Asian J Trop Med Public Health. 1998 Jun;29(2):370-2. 8. Bansal R, Bansal P, Tomar LR. Typhoid and dengue coinfection: case reports. Trop Doct. 2015 Jan;45(1):52-3. doi: 10.1177/0049475514552835. Epub 2014 Oct 14. 9. Sharma Y, Arya V, Jain S, Kumar M, Deka L, Mathur A. Dengue and Typhoid Co- infection- Study from a Government Hospital in North Delhi. J Clin Diagn Res. 2014 Dec;8(12):DC09-11. doi: 10.7860/JCDR/2014/9936.5270. Epub 2014 Dec 5. 10. Srinivasaraghavan R, Narayanan P, Kanimozhi T. Culture proven Salmonella typhi co-infection in a child with Dengue fever: A Case Report. J Infect Dev Ctries. 2015 Sep 27;9(9):1033-5. doi: 10.3855/jidc.5230. VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra