Impact of Recent SARS-CoV-2 Infection on the Course and Severity of Dengue in Children: A Prospective Observational Study from North India.

Namita Ravikumar,Karthi Nallasamy,Gursimran Kaur Mohi,Mahendra Kumar,Muralidharan Jayashree,Suresh Kumar Angurana,Radha Kanta Ratho,Manjinder Singh Randhawa

doi:10.4269/ajtmh.21-0586

Abstract

ABSTRACT.In 2020, a considerable overlap occurred between the COVID-19 pandemic and seasonal dengue transmission in India. This study aimed to evaluate the effects of acute or recent infection with SARS-CoV-2 on the course and outcomes of dengue fever in children. We prospectively enrolled 44 children with a clinical and laboratory diagnosis of dengue fever. Assessment of acute and recent SARS-CoV-2 infection was done using reverse transcription–polymerase chain reaction and IgG antibody through ELISA. Children were grouped based on evidence of SARS-CoV-2 exposure and clinical severity, and outcomes were compared. The median age of the study cohort was 96 months (interquartile range [IQR]: 69–129 months). Fever (98%), vomiting (78%), abdominal pain (68%), hepatomegaly (68%), and edema (32%) were the common features. About two-thirds (N = 30) had severe dengue; 20 (45%) had dengue shock. Liver dysfunction (58%) and acute kidney injury (25%) were other major organ dysfunctions. Nineteen (43%) children stayed in the pediatric intensive care unit for a median duration of 5 days (IQR: 2–11 days). None had acute SARS-CoV2 infection; however, IgG against SARS-CoV-2 was detected in 15 (34%) cases. Children with recent exposure to SARS-CoV-2 showed a trend toward a lower incidence of acute kidney injury, fewer organ dysfunctions, and a lower frequency of invasive ventilation. Four children (9%) died; none of the deaths were in the SARS-CoV-2–exposed group. The present study exposes preliminary evidence that dengue fever might follow a less severe course in children with recent exposure to SARS-CoV-2 infection. However, it is pertinent to understand the antigenic similarity and cross-protective antibody response between the two viruses and their clinical relevance.

Highlights

In 2020, SARS-CoV-2 virus spread rapidly across the globe, resulting in unprecedented health care burden and mortality
The relief was short lived as a new multisystem inflammatory syndrome (MIS-C) emerged, almost exclusively in children, a few weeks after exposure to the virus
Some preliminary studies reported an increased severity of SARS-CoV-2 infection in patients with pulmonary tuberculosis;[7] limited literature is available regarding its association with dengue

Summary

Introduction

In 2020, SARS-CoV-2 virus spread rapidly across the globe, resulting in unprecedented health care burden and mortality. Infection in adults is characterized by primarily respiratory system involvement with a wide range of severity.[1] Children were less severely affected.[2] the relief was short lived as a new multisystem inflammatory syndrome (MIS-C) emerged, almost exclusively in children, a few weeks after exposure to the virus This was characterized by an exaggerated immune response presenting with fever, rash, conjunctival injection, gastrointestinal symptoms, shock, and multi-organ dysfunction.[3] there were some clinical similarities with Kawasaki disease, it was soon identified as a distinct pathological entity with a different immune-pathological phenotype.[4] As more research is being carried out, the immunological effects of SARS-CoV-2 infection are emerging. Some preliminary studies reported an increased severity of SARS-CoV-2 infection in patients with pulmonary tuberculosis;[7] limited literature is available regarding its association with dengue

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