Oropouche fever: clinical characteristics and viral-bacterial coinfections in a region of the Peruvian Amazon: a cross-sectional study

Objectives
Cocirculation of Oropouche virus (OROV) with other endemic pathogens means coinfections can occur. This study aimed to characterize viral and bacterial coinfections in OROV-positive patients, evaluating their clinical features and exploring the impact on hospital stay and antibiotic use across different infection groups.
Methods
Cross-sectional study in an eastern Peruvian Amazon region among patients with acute febrile illness who tested positive for OROV. Patients were stratified into five groups: OROV monoinfection, OROV + dengue virus serotype 2 (DENV-2): American/Asian II coinfection, OROV + Rickettsia coinfection, OROV + Leptospira coinfection, and a control group of OROV-negative febrile patients.
Results
A total of 75 patients were included. Patients with OROV + Leptospira coinfection had the longest mean hospital stay (6.00 SD 1.40). Empirical antibiotic use at admission varied by group (overall 7/75, 9.3%). However, only two cases (both OROV + Leptospira ) had appropriate antibiotic coverage for the confirmed pathogen. In all coinfected groups, there was frequent discordance between initial antibiotic treatment and the etiologic agent. Conclusions
Coinfection with Leptospira was associated with a longer length of hospital stay and was the only scenario in which empiric antibiotic therapy aligned with the true etiology. OROV monoinfections and viral coinfections (with DENV-2 American/Asian II) showed similar clinical profiles, underscoring that routine clinical assessment alone cannot readily distinguish these infections or coinfections.