Coagulopathy of Dengue and COVID-19: Clinical Considerations

Abstract

Thrombocytopenia and platelet dysfunction commonly occur in both dengue and COVID-19 and are related to clinical outcomes. Coagulation and fibrinolytic pathways are activated during an acute dengue infection, and endothelial dysfunction is observed in severe dengue. On the other hand, COVID-19 is characterised by a high prevalence of thrombotic complications, where bleeding is rare and occurs only in advanced stages of critical illness; here thrombin is the central mediator that activates endothelial cells, and elicits a pro-inflammatory reaction followed by platelet aggregation. Serological cross-reactivity may occur between COVID-19 and dengue infection. An important management aspect of COVID-19-induced immunothrombosis associated with thrombocytopenia is anticoagulation with or without aspirin. In contrast, the use of aspirin, nonsteroidal anti-inflammatory drugs and anticoagulants is contraindicated in dengue. Mild to moderate dengue infections are treated with supportive therapy and paracetamol for fever. Severe infection such as dengue haemorrhagic fever and dengue shock syndrome often require escalation to higher levels of support in a critical care facility. The role of therapeutic platelet transfusion is equivocal and should not be routinely used in patients with dengue with thrombocytopaenia and mild bleeding. The use of prophylactic platelet transfusion in dengue fever has strained financial and healthcare systems in endemic areas, together with risks of transfusion-transmitted infections in low- and middle-income countries. There is a clear research gap in the management of dengue with significant bleeding.

Coinfection of COVID-19 and dengue: a case report

“…On the other hand, COVID-19 is characterized by a high prevalence of thrombotic complications, where bleeding is rare and occurs only in advanced stages of critical illness; here thrombin is the central mediator that activates endothelial cells, and elicits a pro-inflammatory reaction followed by platelet aggregation. 3,4 Some cases of coinfection by dengue and SAR-CoV-2 have been reported especially in the dengue-endemic regions. [3][4][5][6] This coinfection would undoubtedly be a dangerous combination disease if not managed cautiously.…”

“…3,4 Some cases of coinfection by dengue and SAR-CoV-2 have been reported especially in the dengue-endemic regions. [3][4][5][6] This coinfection would undoubtedly be a dangerous combination disease if not managed cautiously. The physicians and health authorities should make decision accordingly to prevent the coinfection develops into ecoepidemic.…”

UChOA‐ANN based effective diagnostic model for early detection and accurate prediction of dengue affected blood samples

“…Reduction in such platelets can affect the blood clotting process 8 . Thus it can cause mild and severe blood bleeding and also even can cause death 9 . Therefore, the counting of platelets in blood are an important role in diagnosing dengue fever.…”

COVID-19: Current Status and Future Prospects

“…Our knowledge has expanded on the pathogenesis and treatment of COVID-19 and experience gained within different countries, and this is reflected in the enormous number of scientific papers generated, including those in this Special Issue. There have been 24 papers published upon peer review acceptance in this Special Issue, including 17 research papers [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], 2 review papers [ 20 , 21 ], 1 opinion piece [ 22 ], 1 commentary [ 23 ], and 3 systematic reviews [ 24 , 25 , 26 ]. Each paper in this Special Issue contributes to our understanding of COVID-19.…”

“…There were two review papers in this Special Issue. The first of these was a review examining the coagulopathy of dengue and COVID-19, particularly looking at clinical considerations [ 20 ]. The objective of the second review was to describe the intimate relationship between the gastrointestinal tract, including the liver and pancreas, and the pathogenesis, clinical course, and outcomes of the COVID-19 pandemic.…”