Co-infection of SARS-CoV-2 and dengue virus: a clinical challenge

Abstract

Many regions of the world where dengue epidemics are seasonal are also facing the COVID-19 pandemic. This is a medical concern because both diseases are difficult to distinguish since they have similar clinical symptoms and laboratory findings, and because they have different clinical management. So far, co-infection of SARS-CoV-2 and dengue virus (DENV) has not been studied. Herein we report the first case of a patient with co-infection of COVID-19 and dengue. Both infections were simultaneously laboratory confirmed by positive RT-qPCR for SARS-CoV-2 and RT-qPCR for DENV, NS1, IgM and IgG antibody tests for dengue. The patient had a favorable clinical improvement, without severe symptoms. This case emphasize that, in pandemic era, having a diagnostic of one infection does not rule out the possibility of having another infection concomitantly. In addition, underscores the importance of an accurate and timely diagnosis to prevent the spread of COVID-19.

Viral coinfections in COVID‐19

“…142 Due to the similarity among the symptoms of DF and COVID-19, including fever, cough, myalgia, and petechiae, it is not readily possible to discriminate the two diseases from each other. 142 Skin rashes and reduced platelet counts can also be observed in COVID-19 patients, increasing the likelihood of misdiagnosis. 139,142 Symptoms such as reduced lymphocyte and monocyte counts, elevated glucose levels, and serious respiratory disorders have been reported in cases with SARS-CoV and DENV coinfection.…”

SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

“…In dengue-endemic regions, the situation is aggravated by socio-economic aspects and the occurrence of epidemic arboviruses [ 3 ]. In addition to the first case reported in Brazil, also in the Federal District [ 11 ], SARS-CoV-2/DENV co-infection cases were reported in other tropical and developing countries, where these infections are also considered a defying public health problem [ 13 – 15 ]. The co-infection cases described to date, together with the 13 cases reported herein, highlight the difficulty in reaching the final diagnosis, since both diseases share similar signs, symptoms and laboratory features.…”

“…As dengue fever and COVID-19 require different clinical management, incorrect or delayed diagnosis can have serious consequences [ 11 ]. The use of anticoagulants is especially concerning since they are frequently used in COVID-19 patients to protect against thrombotic events, but should be avoided in all patients with dengue fever, as they can increase the risk of thrombocytopenia and even trigger Reyes syndrome, a rare condition characterized by hepatitis and encephalopathy [ 17 ].…”

“…In light of the current pandemic scenario, several other infections may share an array of symptoms with COVID-19. Limited data are available in the literature regarding the SARS-CoV-2/DENV co-infection, with a single case reported in an urban area of Brazil, where the patient progressed to a favorable outcome [ 11 ]. Thus, it is necessary to understand the spectrum of this co-infection for timely diagnosis and tailored clinical management, which could prove lifesaving in severe cases.…”

Successful management of dengue in renal transplant recipients: A retrospective cohort from a single center

“…In today's era, coronavirus disease (COVID-19) has drastically impacted the transplantation community 31,32 and in endemic regions of dengue, co-infection with COVID-19 poses an arduous clinical challenge, as the management of both is different. 33 Co-infection of COVID-19 and dengue is a potential threat to the global health community. 34,35 The transplantation community, especially in the dengue-endemic regions should be meticulous in their approach with COVID-19 with a high degree of clinical suspicion for dengue.…”