Dengue and SARS-COV-2 co-infection in pregnancy: decision making dilemma

Abstract

Background: Dengue virus (DENV) and coronavirus disease 2019 (COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) are two viral illnesses that require very distinct management protocols. Missed diagnosis and under reporting of DENV is predicted due to COVID-19 pandemic. Pregnancy is associated with increased fetal and maternal morbidity and mortality due to both illnesses. Co-infection need to be reported and studied to optimize the outcomes. Methods: This is a retrospective study on pregnant patients with COVID-19 and DENV co-infection conducted from the medical records from 1st of April 2021 to 1st of September 2021. Results: In this series four patients are described. Patient 1 is a diagnosed patient with immune thrombocytopenic purpura who was in remission. She developed DENV infection during recovery of SARS-CoV-2. She received intensive care unit (ICU) care during the leaking phase. Patient 2 had an uncomplicated miscarriage during the co-infection. Patient 3 was a patient with advanced maternal age with multiple co-morbidities. She did not progress into the leaking phase. Diagnosis of DENV was missed in patient 4 and she had a fetal death. Conclusions: SARS-CoV-2 and DENV co-infection in pregnancy can be life threatening to the mother and can lead to adverse fatal outcomes. Timely diagnosis and multidisciplinary management are essential for better outcomes. Continuous data collection and reporting is advisable till the guidance is formed.