Dengue Fever with Corona Virus Disease 2019: Is it a “Double Trouble” with Concurrent Both Diseases or Single Disease with “Polyhedron” Nature and Antigenic Cross Reactivity?

Radiological phenotypes are radiological patterns or observable characteristics of COVID19 pneumonia. Various phenotypic classifications have been reported in literature. CT severity radiological phenotypes are widely used and universally accepted radiological phenotypic methods. Radiological CT severity phenotypic differentiation has documented very crucial role in initial assessment and during triaging of these cases in indoor and outdoor setting. Typical COVID-19 lung parenchymal involvement described as predominant ground glass opacities (GGOs) and consolidations in peripheral and subpleural portion of any lobe, predominantly involving lower lobes. Atypical Radiological patterns in COVID-19 has been documented as bronchopneumonia, multifocal consolidations, necrotizing pneumonia, cavitations with GGOs with or without consolidations. In present case report, 43-year male, presented with acute febrile respiratory illness with acute hypoxic respiratory failure documented as oxygen saturation of 80% at room air with tachypnea and respiratory distress. HRCT thorax was showing Pleural based, peripheral, central, multifocal patchy, confluent & ill-defined GGOs and consolidations in bilateral lung fields in upper, middle and lower lobes. These typical radiological features suggestive of bronchopneumonia like radiological pattern which was very unusual for typical COVID-19 radiology. His laboratory parameters have shown abnormally raised inflammatory markers like CRP, Ferritin, LDH, D-Dimer and IL-6. Importantly, his random blood sugars were raised with abnormally raised HbA1c levels to label as diabetes mellitus. He was diagnosed with diabetes mellitus this time with COVID-19 illness without use of steroids. He was treated with standardized COVID-19 management institutional protocol with combination of low molecular weight heparin, methylprednisolone, remdesivir, meropenem and teicoplanin. Patient required BIPAP support with higher oxygen requirement with nasals canula for one week due to advanced radiological disease with more anatomical involvement. We have documented successful treatment outcome with use of rational treatment in timely by predicting disease severity with use of composite analysis of clinical, laboratory and radiological markers of illness. Transient hyperglycemia is known to occur and reported after COVID-19 illness due to virus induced inflammatory response and pancreatopathy with beta cell dysfunction. Transient hyperglycemia can be easily managed with insulin during hospitalization and oral anti-diabetic agents after discharge for few weeks. Dietary and lifestyle modification will help in majority with complete reversal of abnormally high sugar levels with restoration of normal HbA1c levels to non-diabetic range.

Section: Discussionmentioning

confidence: 99%

Covid-19 Pneumonia Presenting as a ‘Typical Radiological Bronchopneumonia’ Pattern in Clinical-Radiological-Pathological Phenotype with Transient Hyperglycemia

Patil,

Tak

2024

Section: Discussionmentioning

confidence: 99%

Unilateral Lung Parenchymal Infiltrates with GGO & Evolving Consolidation as Presenting Feature of Sporadic COVID-19 Pneumonia in Post Pandemic Era in a Patient with Acute Febrile Respiratory Illness

Patil,

Tak

2024

Sporadic COVID-19 cases will be predicted to occur in coming few years ahead as observed in previously known influenza virus related pandemics. Herd immunity due to natural infection and hybrid immunity after COVID-19 vaccination has played crucial role in waning of this pandemic. COVID-19 pneumonia has a very ‘typical’ radiological presentations, observed globally; classified as GGO and consolidations involving peripheral parts of lung, bilateral disease, predominantly pleural based areas initially and involves central portions as disease process advances. Such radiological presentations are never documented in history before this pandemic, which has helped in suspecting COVID-19 illness in cases with negative microbiological results initially and such illness were classified as SARI (severe acute respiratory illness). Cases with typical radiological features for COVID-19 with RT PCR positive results were defined as case of COVID-19 illness. Both the clinical scenarios were managed with similar protocol during hospitalization. COVID-19 case burden has significantly decreased in last one year since declaration of end of pandemic by WHO and now we are in post pandemic phase. Since beginnings of pandemic, many corona virus variants were emerged with variable infectivity, virulence, pathogenesis, mortality and morbidity. As pandemic is over, cases are rarely observed with lung involvement, COVID RT PCR testing, HRCT reporting’s in line with pandemic protocol and requirement of resources to treat these cases are less required and utilized today. In present case report, 32-year male, presented in outdoor unit with history of acute febrile respiratory illness with dry cough, high grade fever and chest tightness and chest discomfort of acute onset. HRCT thorax documented Pleural based, peripheral, unifocal or solitary opacity with predominant GGOs in right lower lobe with normal left lung. He is treated in indoor unit in line with community acquired pneumonia protocol and observed clinical worsening with four-fold raised in inflammatory markers. Oxygenation is worsened and raised IL-6, CRP and LDH has given clue to think towards COVID-19 etiology. Thorat swab for COVID-19 RT PCR is positive and managed according to protocol for COVID-19 illness. This is the only observed COVID-19 pneumonia case in last six months, in which; clinical-radiological patters were typical of pandemic illness of second wave of COVID-19 illness due to delta variant. Our case is the sporadic case reported with all clinical features of pandemic illness. We have suspected COVID-19 etiology in spite of ‘atypical unilateral lung involvement’ due to worsened clinical features and abnormally raised inflammatory markers with poor response to standard treatment protocol for community acquired pneumonia. High index of suspicion is must, and; timely interventions with use of rational treatment including remdesivir, heparin & steroids combination during hospitalization has documented successful outcome. We recommend COVID-19 RT PCR testing in all community acquired cases nonresponding to standard guidelines to have timely diagnosis and treatment. Sporadic cases rare to occur, and they do occur for few years ahead of this end of pandemic due to virus variant, and we must quote ‘rare things are not rare to happen’.

“…Inflammatory markers has been studied for predicting antigenic cross-reactivity and antigenic mimicry which has resulted in autoimmune and rheumatological manifestations. During COVID-19 pandemic antigenic cross reactivity has documented with dengue fever [10][11][12][13]. Similarly, deregulated immune phenomenon has been documented after covid vaccination and transient autoimmune features have been reported in various studies [14][15].…”

mentioning

confidence: 92%

Hydroxychloroquine as ‘Potential Treatment Option’ for Persistent Immune Dysregulation in Long COVID: Revisiting Its New Use as a ‘Versatile’ Molecule!

Patil,

Gondhali

2023

COVID-19 pandemic is over now and we are in great peace of relief after three years of first case reported in China. This pandemic has observed a significant impact on quality of life globally and this puts unforgettable imprints on the history of mankind. Reason for more havoc in this pandemic was less studied virus before this ‘unpredicted or surprise pandemic’ by medical scientists regarding its pathophysiology, available treatment options and lack of effective vaccine to tackle this dragon. Rationale would be COVID-19 is the first observed and reported pandemic of corona virus related global disease apart from its previously occurring SARS and MERS Epidemics. Fast track developments in medical treatment options with use of ultrafast digital and artificial intelligence techniques have curtailed mortality on a large scale globally. Although mortality is significantly reduced, morbidity is documented in significant number of cases worldwide after this Dragon related pandemic. Morbidity due to COVID-19 now called as ‘Long COVID’, which is underreported & half-heartedly evaluated globally. Long COVID is related to persistent immune dysregulation which occurred during evolution of COVID-19 as a natural trend of disease & documented during the course of active viremia, during recovery of viral illness and after the post viral phase. Immune dysregulation occurs in a ‘selected group’ of cases irrespective of disease severity and vaccination status, and observed in cases irrespective of severity of illness as with negligible illness resulted into brainstorming effect on medical scientists and researchers as of today to advanced and mandates further global research. Globally, one third of recovered or affected cases of COVID-19 are facing long covid and need prompt treatment options to tackle this dragon related long term effect on body. ‘Immunomodulatory’ or immunity modifying agents are the primary targets to curtail immune dysregulation and long covid. Some experts recommend ‘disease modifying agents’ to treat long covid cases. Still, many miles to go to reach effective treatment options for long covid and we don’t have effective options as of now for this ‘health issue of global concern’ related to Dragon. Hydroxychloroquine is initially used as an antimalarial and as an anti-inflammatory molecule for decades in various rheumatic conditions with satisfactory results. Despite decades of dependable use and predictable results in the treatment of rheumatic disease, HCQ remains a drug with an ever-expanding number of underlying mechanisms. HCQ was tried initially for prophylaxis treatment of COVID-19 due to its anti-inflammatory properties but has not shown any dramatic results. WHO has removed HCQ from the treatment plan after many trial results with disappointing outcomes. HCQ is a drug with multiple beneficial pleiotropic effects such as immunomodulatory effects which regulates immunological responses that inhibit dysregulated immune system. These Immunomodulatory and or diseases modifying effects of HCQ makes it the future candidate with ‘game changer’ role for management of Long covid resulting from immune dysregulation as a core pathophysiologic pathway of this Dragon Pandemic. Revisiting this old drug with ‘versatile effects’ can be used as treatment option for short time as frontline molecule for Long covid when no definitive options are available after consideration of risk benefit ratio which is a cost-effective treatment option.