A case of coinfection of a pediatric patient with acute SARS-COV-2 with MIS-C and severe DENV-2 in Mexico: a case report

Abstract

Background COVID-19 cases have been increasing since the epidemic started. One of the major concerns is how clinical symptomatology would behave after coinfection with another virus. Case presentation In this case report, a pediatric native patient from Estado de Mexico (EDOMEX), MEX had severe DENV-2 and acute SARS-CoV-2 at the same time. The clinical features were severe thrombocytopenia, secondary septic shock, cerebral edema, pericardial effusion, fluid overload that exhibited bipalpebral edema in all four extremities, hemophagocytic lymphohistiocytosis (HLH), coronary artery ectasia (CAE), multisystemic inflammatory syndrome in children (MIS-C), and probable COVID-19 pneumonia or acute respiratory distress syndrome (ARDS) that triggered patient intubation. The patient presented unusual symptomatology according to the literature. After 15 days of intubation and 15 more days under surveillance, he was released without respiratory sequelae and without treatment after major clinical improvement. Conclusion The aim of this manuscript is to present clinical challenges that coinfection may cause in pediatric patients, even though COVID-19 in children does not tend to be as severe as in other sectors of the population.

Global Coinfections with Bacteria, Fungi, and Respiratory Viruses in Children with SARS-CoV-2: A Systematic Review and Meta-Analysis

“…The median patient age ranged from 1.4 months to 144 months across studies. There was an increased male predominance in pediatric COVID-19 patients diagnosed with bacterial, fungal, and/or viral coinfections in most of the studies (male gender: n = 204, 59.1% compared to female gender: n = 141, 40.9%) [6,8,10,11,[16][17][18][19][21][22][23]31,35,38,40,[45][46][47][48]52,54,57,[59][60][61]63,64,[67][68][69][70][71]74,76,77,81,90,93,95,97,104,105,107,111,113,114,117,118,121,…”

“…Only four studies were conducted within multiple countries (n = 4) [53,109,118,127]. The majority of the studies were single-center [4,6,[11][12][13][14][15][16]18,19,[21][22][23][32][33][34][35][38][39][40][41][43][44][45][46][48][49][50][51][52][55][56][57][59][60][61][62][64][65][66][67][68][69][70][72][73][74][75]…”

“…The majority (n = 128) of the studies included any hospitalized patient, except for two studies that investigated potential of SARS-CoV-2 transmission in a cluster and genomic analysis of SARS-CoV-2 in a family [47,62], and two studies included only critically ill COVID-19 patients [9,18]. Eleven, four, and one studies exclusively reported on respiratory viral [10,18,31,35,61,71,73,89,101,125,140], bacterial [11,96,100,112], and fungal [90] coinfections, respectively; the remaining 114 studies reported on bacterial, fungal, and respiratory viral coinfections [4][5][6][7][8][9][12][13][14][15][16][17][19][20][21][22][23][32][33][34][62][63][64][65][66][67][68]…”

Presentations and outcomes of familial hemophagocytic lymphohistiocytosis in the pediatric intensive care units (PICUs)

“…It is noteworthy that the literature also compares the cytokine release syndrome which could lead to such multiorgan involvement in HLH with the COVID-19 cytokine storm ( 25 ). A case report of HLH associated with COVID-19 presents more clinical challenges that coinfection may cause in children ( 26 ). Future research on multimodal therapies for cytokine release syndrome could show more potential ( 27 ).…”

Secondary hemophagocytic lymphohistiocytosis in children (Review)

“…Sars-Cov2 infection, causative of the recent COVID19 pandemic, has been reported to also be a HLH trigger, mostly in adults ( 102 , 103 ). In 2021, a Mexican group reported the unusual case of a 7-years old boy that developed a severe inflammatory syndrome triggered by Sars-Cov-2 and Dengue virus coinfection ( 104 ). The authors diagnosed both multisystemic inflammatory syndrome in children (MIS-C) for the presence of coronary involvement and HLH for fulfilling the HLH 2004 criteria.…”