A Case Report: Severe Dengue Infection and Coinfection with Human Parainfluenza Virus-3


Dengue hemorrhagic fever
Human parainfluenza virus-3
Ns1 antigen
Ns1 Ag
Supportive care



Dengue infection is an endemic disease in Southeast Asia. Cambodia is located in Southeast Asia and has a belt of disease distribution. According to the Cambodia National Dengue Control Program, thousands of cases are reported annually, and the mortality rate significantly decreased from 1.19% to 0.9% between 2002 and 2020. Human parainfluenza virus (HPIV) is the second most common respiratory virus infection in children followed by respiratory syncytial virus. In the past, there has had no case reports of dengue virus and HPIV co-detection, which makes it challenging for clinicians to comprehend this mixed infection. Therefore, we present our first confirmed case, which we were able to share with other physicians to enhance their knowledge and experience.

Case Presentation

A 4-year-old girl was initially diagnosed with Dengue infection (Ns1 Ag+) upon her admission to the National Pediatric Hospital. She arrived complaining of malaise, coughing, and a high fever for 2 days. In the following days, she presented with a severe form of dengue (dengue hemorrhagic fever) with plasma leakage, bleeding, electrolyte imbalance and organ compromise. After passing the critical phase of dengue, which is usually the patient's recovery period, she did not. She required prolonged oxygen therapy sessions and exclusively supportive care, as her respiratory system continued to worsen. Additionally, her extremely elevated liver enzymes raised concerns regarding her liver function. This could lead to liver failure and death. Later, her conditions were found to be associated with HPIV-3 coinfection. Significantly, she managed to recover completely despite having a prolonged fever for ten days and eleven days after being admitted.


Dengue and HPIV-3 coinfection can cause serious health problems. The clinical manifestations of the patient were persistent, complicated, deterioration, and prolonged hospitalization. Any unusual presentation of dengue infection should be suspected of comorbidity or coinfections. However, further observations and the collection of other future data are needed for more evidence.