Co-infection of SARS-CoV-2 with Dengue Fever-A Case Report

Abstract

The current pandemic circulation of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) along with Dengue Virus (DENV) in disease endemic countries may produce unfavourable circumstances with co-infection, delays in emergency mitigation measures and management of the disease as both the viral diseases have many similar close characteristics and presentations. This is a case report of a 50-year-old diabetic and hypertensive female admitted with complaints of fever with chills for one week duration. On initial evaluation due to the ongoing pandemic as per the protocol, the patient was found negative with rapid antigen testing for SARS-CoV-2, Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test along with negative High-Resolution Computed Tomography (HRCT) of the chest. Basic initial investigations suggested decreased platelet count and elevated acute phase proteins. Two days after admission, the patient was found to be Dengue IgM and IgG positive and the patient’s symptoms were managed accordingly. Later, the patient suddenly showed decrease in oxygen saturations and warranted a ventilator immediately. The CT pulmonary angiogram was done to rule out suspected pulmonary thromboembolism, which was showing infective lesions with Coronavirus disease 2019 Reporting and Data System grade 4 (CO-RADS 4). Repeat RT-PCR for SARS-CoV-2 was positive. The Patient was immediately shifted to high isolation Intensive Care Unit (ICU) and treated according to the Standard Operating Protocol (SOP) of SARS-CoV-2 infection. The overlapping clinical presentations of SARS-CoV-2 infection and DENV in resource- constrained settings and the complexities of interpreting results make identification of SARS-CoV-2 in the dengue endemic areas difficult. Therefore, a high degree of alertness should be maintained for SARS-CoV-2 infection in DENV endemic areas.