SHM Converge Scientific Abstract ePoster Gallery-Quadruple Threat: Co-Infection With Typhoid Fever, Hbv, Dengue, and Influenza.

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This case describes a 33-year-old man who returned from India with a rare “quadruple” co-infection: typhoid fever, acute hepatitis B, dengue, and influenza B. He first presented with fever and right upper quadrant pain, markedly abnormal liver tests, and jaundice, with labs confirming acute HBV, dengue, and Salmonella typhi infection. He was discharged on oral faropenem.<br /><br />Two weeks later, he re-presented with fever, abdominal pain, and bloody stools. Although his liver tests had improved, blood and stool cultures still grew S. typhi, and imaging showed ileocolitis and a steatotic liver. He was also found to have influenza B. He was successfully treated with ceftriaxone and oseltamivir, with symptom resolution.<br /><br />The report highlights several teaching points: typhoid fever remains a major global health problem, especially in South Asia, where drug resistance is increasing. HBV-related immune dysfunction may predispose patients to intracellular pathogens like Salmonella typhi. The case also raises concern about the limited effectiveness of oral faropenem and the risk of promoting carbapenem resistance.<br /><br />Overall, this case illustrates the importance of considering multiple concurrent tropical and viral infections in travelers returning from endemic regions, especially when hepatitis and persistent bacteremia are present.

Asset Subtitle

Kailey S. Singh

Meta Tag

Author List Bryant Faria, Humail Patel, Ji-Cheng (Jason) Hsieh, Justin Lin, Kailey S. Singh, Valli Mani

Category Clinical Vignettes

Concept Coinfection

Concept Salmonella typhi infection

Concept Acute Hepatitis

Concept Hepatitis B Infection

Concept Dengue

Distinguished Non-Finalist

Presenter Organization Northwell NS/LIJ Internal Medicine Residency Program

Presenting Author Kailey S. Singh

Track Adult

Keywords

typhoid fever

acute hepatitis B

dengue

influenza B

Salmonella typhi

co-infection

travel medicine

South Asia

bacteremia

drug resistance

Coinfection

Salmonella typhi infection

Acute Hepatitis

Hepatitis B Infection

Dengue