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 Table of Contents  
Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 111-116

Concurrent dengue and tuberculosis: An estimated incidence in endemic tropical country and explanation for low observed incidence

1 Sanitation1 Academic Center, Bangkok, Thailand
2 Department of Commnunity Medicine, Dr. D.Y. Patil University, Pune, Maharashtra, India

Date of Submission13-Feb-2019
Date of Decision10-Mar-2019
Date of Acceptance09-Apr-2019
Date of Web Publication17-Jun-2019

Correspondence Address:
Dr. Beuy Joob
Sanitation1 Medical Academic Center, Bangkok
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bbrj.bbrj_37_19

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Background: In tropical developing countries, there are several common infectious diseases including tuberculosis and dengue. The concurrence between dengue and tuberculosis is possible. Methods: Here, the authors perform a mathematical model study to estimate the incidence of concurrent dengue and tuberculosis in Thailand, a tropical country in Indochina. The estimation is performed based on joint probability principle. Results: The estimated incidence of concurrent dengue and tuberculosis in the studied setting is equal to 0.148/100,000 population. Conclusion: There is a low incidence of concurrent dengue and tuberculosis, and this might be due to several possible reasons.

Keywords: Concurrent, dengue, incidence, tuberculosis

How to cite this article:
Joob B, Wiwanitkit V. Concurrent dengue and tuberculosis: An estimated incidence in endemic tropical country and explanation for low observed incidence. Biomed Biotechnol Res J 2019;3:111-6

How to cite this URL:
Joob B, Wiwanitkit V. Concurrent dengue and tuberculosis: An estimated incidence in endemic tropical country and explanation for low observed incidence. Biomed Biotechnol Res J [serial online] 2019 [cited 2022 May 20];3:111-6. Available from: https://www.bmbtrj.org/text.asp?2019/3/2/111/260480

  Introduction Top

There are several problems in clinical practice. Infection is an important group of medical disorder in medicine. Infection is a specific pathological process caused by an infectious agent. According to the medical epidemiological principle, there are three important components or triad for the occurrence of an infection, pathogen, host or patient, and surrounding environment. The infection might be due to several possible pathogens including bacteria, virus, fungus, and parasite. If the host and pathogen coexist in the same surrounding environment at the same time and same place, there might be a chance that there will be an interaction between host and pathogen. If the pathogen has an active virulence, it might invade the host barrier, and if the pathogen is strong enough to conquer the defensive pathogen of the host, the infection might finally occur.

There are several important infections around the world. The infection is observable in any setting around the world. However, the infection is more common in some specific areas of the world. In tropical developing countries, there are several common infectious diseases.[1],[2],[3],[4],[5] Several diseases are common due to the tropical climate and the common nature of developing countries of most tropical countries. Ezzati et al. noted that special acting on noncommunicable diseases in low- and middle-income tropical countries, where under-resourced and inaccessible health care, was necessary.[6] Ezzati et al. mentioned that poor health in tropical poor developing countries is one of the infections and parasites, contrasting with wealthy Western rich developed countries.[6] In fact, access to critical care is a common public health problem detectable in several areas of the world. This is still an increasing problem at present. Several medical problems still exist in developing countries. Of those several problems, the infectious diseases often occur and comprise the largest disease burden.[7],[8],[9] Globally, the infectious disease is still the main public health threaten. Improving access to public health care for neglected tropical infectious diseases in developing countries: lessons are the main target for public health manipulation in tropical medicine.[8]

Focusing on infectious disease, the diseases are usually related with poor sanitation background.[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23] Freeman et al. noted that there were positive impacts of sanitation on aspects of health. Freeman et al. also mentioned that there were gaps for further research to achieve sanitation implementation.[11] Speich et al. mentioned that availability and use of sanitation facilities and water treatment were strongly related to infectious disease in tropical world. Speich et al. also mentioned the importance of health education and hygiene behavior on infectious disease control.[16] Basic hygienic practice is an important tool for the management of important infectious disease.[20],[24],[25],[26],[27],[28],[29],[30],[31],[32] For example, hand sanitation is the main effective measure against diarrhea and respiratory infectious diseases.[33],[34],[35] Perry et al. noted that the attempt to promote sanitation through community medicine approach was important and had to be specially designed.[25]

As already mentioned, the background sanitation problem is relating to the occurrence of infectious disease. Many infectious disease outbreaks are relating to the poor sanitation background in the outbreak settings.[36],[37],[38],[39],[40],[41],[42] Indeed, mosquito-borne disease is a disease transmitted through mosquito, an important vector in medicine. The vector abundance is usually related to the sanitation background. Mwangangi et al. noted that mosquito species abundance was directly related to infrastructure, poor access to health service, water and sanitation services, increasing population density, and widespread poverty in a setting.[43]

In the settings with poor sanitation, background, the common diseases include gastrointestinal infection respiratory infection and mosquito-borne infection. Regarding respiratory infection, tuberculosis is a well-known disease that is presently common in several tropical developing countries. For mosquito-borne infectious disease, dengue is a common disease.[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57] Since the mosquito-borne infectious disease is considered common problem in tropical countries, there is a chance that there might be a concurrence between a mosquito-borne infectious disease and another common tropical disease in developing tropical countries. Of several common infections detectable in tropical developing countries, tuberculosis is considered as a main important public health threaten.[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63],[64],[65],[66],[67],[68],[69],[70] As a mycobacterial infection, tuberculosis usually causes a chronic infection in affected patients. The patients might present several clinical problems. Of those problems, the lung problem is common and is the most common problem in clinically active patients.

In clinical practice, the concurrence between dengue and tuberculosis is possible. Of interest, both diseases are considered important neglected diseases.[71] There are many reports from several tropical countries showing high prevalence of dengue as well as tuberculosis. Nevertheless, in endemic settings, especially for Southeast Asia, dengue is usually less prevalent than tuberculosis.[72] In a recent report from the Philippines, Undurraga et al. reported that dengue was a substantial burden.[72] Undurraga et al. mentioned that dengue accounted for about 10% of the burden of tuberculosis.[72] The concurrence between tuberculosis and dengue is an interesting situation, but it is rarely reported. The first report is by Joob and Wiwanitkit.[73] Joob and Wiwanitkit found that the concurrent infection between dengue and tuberculosis is possible, and the concurrence might affect the clinical course of both diseases.[73] The lung hemorrhage is possible and becomes an interesting problem in concurrence.

  Methods Top

This is a clinical epidemiological investigation based on the available registered data. The aim of the present work is to estimate the incidence of concurrent dengue and tuberculosis. The studied setting is Thailand, a tropical country in Indochina. In Thailand, both dengue and tuberculosis are endemic. The mathematical model technique is used for estimation. Briefly, the estimation is performed based on joint probability principle. Briefly, joint probability is a statistical method that is useful for calculating the likelihood of two concurrent events which occurring together at the same time and same place.

The estimated incidence of concurrent dengue and tuberculosis is calculated according to this formulation: “incidence of concurrent dengue and tuberculosis = incidence of dengue × incidence of tuberculosis.” The technique used in this study is the standard technique as used in previous referencing studies.[74],[75],[76] In the present study, the incidence of dengue and tuberculosis is referred to the data provided by Thai Center for Disease Control. The updated data on the year 2018 are used in the present study. This is a mathematical model study based on the public available epidemiological data and required no written informed consent or ethical approval.

  Results Top

The reported incidence of dengue in Thailand is equal to 86.48/100,000 population, whereas the reported incidence of tuberculosis in Thailand is equal to 171/100,000 population [Table 1]. The estimated incidence of concurrent dengue and tuberculosis in the studied setting is equal to 0.148/100,000 population.
Table 1: Basic statistical data for the mathematical model study to assess the estimated incidence of concurrent dengue and tuberculosis

Click here to view

  Discussion Top

Vector is the specific living thing that can transmit the disease to the human beings. There are several kinds of vectors. The good examples are tick and mosquito. In medicine, vector can play an important role in transmission of disease, and the disease that can be transmitted by vector is called vector-borne disease. Vector-borne disease is an important public health problem. This kind of disease is observable in many countries. The disease is highly endemic in tropical zone. There are many kinds of tropical mosquito-borne infectious diseases such as malaria, dengue, chikungunya, and Zika virus infection. The mosquito-borne infectious diseases are usually problematic and hard to manage. Since the disease is transmitted by mosquito, the main prevention of mosquito-borne infectious disease is usually based on mosquito control. Nevertheless, the preventive measure against mosquito is usually not effective.[77],[78],[79],[80],[81],[82],[83] The tropical climate helps promote the breeding of mosquito vector, and therefore, the mosquito-borne infectious disease is very common in many tropical countries.

Dengue is an important arbovirus infection. This infection is very common in tropical areas including Indochina. Dengue is an acute febrile illness, and the patient usually presents with high fever and hemorrhagic complications. This clinical presentation is common and might be similar to other tropical infection. Hence, the basic laboratory investigation is usually required for the diagnosis. The patient usually has a positive tourniquet test, and blood test can show specific complete blood count pattern.[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95] The patients usually have atypical lymphocytosis, hemoconcentration, and thrombocytopenia.[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95] In the most severe case, the patient might develop a severe clinical presentation, namely dengue hemorrhagic fever. In dengue hemorrhagic fever, the severe bleeding is possible. If there is any internal organ bleeding, the clinical problem will be severe. In some case, bleeding might also occur at neurological system, and the urgent clinical treatment is required. The patient might develop shock. In dengue shock syndrome, the final outcome might be death.[96],[97],[98],[99] For the management of dengue, the disease is usually self-limited. The fluid replacement therapy is the standard therapeutic method. The patient usually responds to the good fluid replacement therapy, and the dramatic response to the treatment is common.[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95]

Dengue and tuberculosis are still the important public health problems in several areas around the world. Both diseases can exist in the same endemic area. Furthermore, both diseases are reported as the etiologies of severe clinical problems. For example, in a recent report on encephalitis syndrome in Cambodia, a tropical country in Indochina, both dengue and tuberculosis could be identified as associated infectious diseases in the local patients.[100] In a recent report from Brazil, a tropical country in South America, tuberculosis was observed in 28.6% of cases with dengue patients presenting the central nervous system problem.[101] If there is no good investigation, the concurrence will be easily overlooked and neglected. To investigate the possible concurrence of both diseases becomes a very important clinical note in tropical medicine.[73],[101]

In addition, the foreigners who visit the endemic areas for a long period, there is also an increased risk to get both diseases, dengue, and tuberculosis.[102] In a recent report on development aid workers from New Zealand. Working at tropical countries, the evidence of dengue fever seroconversion was found at a rate of 3.4/1000 person months on assignment, and the evidence of TB during assignment was detected at a rate of 1.4/1000 person months on assignment.[102] For the police from New Zealand deploying overseas, the evidence of dengue fever seroconversion was found at a rate of 8.57/1000 pdm and the evidence of TB during assignment was detected at a rate of 2.92/1000 pdm.[103] In Thailand, a tropical country in Southeast Asia, dengue is highly prevalent and tuberculosis is also highly endemic.[104],[105] Due to the tropical climate, both diseases are very common.[104],[106],[107] Both diseases are the important local public health threatens. An interesting consideration is the extremely low rate of the report on the concurrent case of dengue and tuberculosis. In the present mathematical model, it can show that the concurrence is extremely rare. Considering the mathematical model study, the final results can show that there is still a possibility that the concurrence between dengue and tuberculosis can occur. The rate about 1.48 per million is derived. This is considered low but still exists. Nevertheless, an interesting consideration is the lack of report on concurrence in our setting. Based on the fact that the number of population in Thailand is around 60 million, there should be much more than ten reported cases. However, the registered data show extremely lower rate. The first case was documented on 2013, and there is no other additional report.[73] The possible explanation might be the underreporting of the case for both dengue and tuberculosis. In fact, as a country in the tropical region, dengue is usually prevalent. If the local sanitation is poor, the high prevalence will also be high. In a recent report from Laos, another Indochina country with poor public health system, in 2016, the cause of fever among pregnant women was analyzed.[108] According to that study, both dengue and tuberculosis are common etiologies of fever. The concurrent infection is also observable.[108] In another Indochina country, Singapore, the high prevalence of dengue is also observable. In the migrant workers in Singapore, who usually have poorer sanitation than local people, the high prevalence of tuberculosis is also observed.[109]

Another possible explanation might be the possibility of some pathophysiological pathway in both diseases that might counteract and decrease the chance of occurrence each other. In addition, there might be the third additional concurrent medical condition that might alter the final clinical expression. Further research on this specific area is warranted.

  Conclusion Top

Based on the present study, due to the joint probability analysis, there is a low incidence of concurrent dengue and tuberculosis, and this might be due to several possible reasons. Nevertheless, there might be a problem of under-recognition of the possible concurrence between dengue and tuberculosis.

Ethical issue

This work is a mathematical model-based study. It does not deal with any patients or animals or clinical samples, and hence, it requires no written informed consent or ethical approval.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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