Co-infection of dengue and COVID-19
34yrs/M admitted with C/o Generalized bodyaches,3 day history of on and off fever which is temporarily relieved by paracetamol,Hypogastric pain,He also experienced nausea and vomitting with loss of appetite.NO PETECHIAE OR RASES present over body.He was tested negative for COVID 19 but positive for dengue.On day 2 admission patient developed dry cough and mild difficulty in breathing. NEED SUGGESTIONS? Chief Complaints Fever,bodyaches,NV, Abdomen pain History No relevant medical history Vitals BP - 120/80,HR -110,Temp -99°F,Spo2 -98% without O2 support,RR - 18 Investigations COVID - RT PCR - NEGATIVE DENGUE IGg - Positive Platelet counts -4000,Hb -12,TLC -12000 HRCT chest enclosed
HRCT CHEST - Describes lesions as CORADS - || - Corads - 2 lesions in HRCT chest is indicative of infective pathology- and less chance of COVID-19 disease. Considering RT - PCR- Negative, TLC , 12000 , Dengue IgG positive , Platelets- 4000 , SPO2- 98 % without Oxygen, RR - 18 - It is unlikely to be a case of COVID-19. Most likely Dengue fever with secondary non - covid Viral pneumonia or bacterial pneumonia. Although in D/D - COVID-19 is a possibility. As SPO2 is 98 % without Oxygen- No Oxygen support is required. Infact patient needs to be treated on following lines 1.Platelet transfusions - with target to keep Platelet count above 20 , 000 with daily testing of Platelet count 2.Parenteral antibiotics- Inj cefoperazone 2 gm B.D 3.Inj Pantoprazole IV daily 4.Regular monitoring of ABG studies 5 A repeat RT - PCR from broncho - pulmonary lavage 6.Symptomatic treatment with- Paracetamol,and other supportive treatment
Dear dr Prashant ved it is a confirmed c/o covid19 pneumonitis as seen from hrct Certainly IgG +ve for dengue fever raises confusion but lesion seen are more pointing to covid19 likely igg is false +ve As delayed symptoms developing like sob are more of covid infection Platelets are only 4000 thrombocytopenia is not seen in covid Yes we need to keep watch it carefully
HRCT CHEST - Describes lesions as CORADS - || - Corads - 2 lesions in HRCT chest is indicative of infective pathology- and less chance of COVID-19 disease. Considering RT - PCR- Negative, TLC , 12000 , Dengue IgG positive , Platelets- 4000 , SPO2- 98 % without Oxygen, RR - 18 - It is unlikely to be a case of COVID-19. Most likely Dengue fever with secondary non - covid Viral pneumonia or bacterial pneumonia. Although in D/D - COVID-19 is a possibility. As SPO2 is 98 % without Oxygen- No Oxygen support is required. Infact patient needs to be treated on following lines 1.Platelet transfusions - with target to keep Platelet count above 20 , 000 with daily testing of Platelet count 2.Parenteral antibiotics- Inj cefoperazone 2 gm B.D 3.Inj Pantoprazole IV daily 4.Regular monitoring of ABG studies 5 A repeat RT - PCR from broncho - pulmonary lavage 6.Symptomatic treatment with- Paracetamol,and other supportive treatment
This pt. have Covid 19 only and no Denge fever. The titer of IgG Dengue is crossreactive titer which allwage come +ve with corona viral infections It is fols titer. So if you whant to conform it then you do Dengue teast by ELISA.method. only. Treat this pt. As a case of Covid 19 only
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Pure case of sarscov2 Definitely ground glass pneumonitis with tree in bud appearance leucocytosis Igg is past infection do ns1 Manual count platelet if less then10000 then sm pletelet drip repeat RT PCR clia on 4 or5 day of fever CRP ddimer il6 LDH neutrophil Lyumphocyte ratio sgpt serum creatinine ecg 2 decho then treat
Past dengue igg positive Ground glass pneumonitis Rt pcr negative Repeat after 4 days Thrombocytopenai Pletelet drip Repeat platelet after 12 hr Leucocytosis Opinion of physician
Dengue IgG for dengue positive. Platelet count 4000 ? Typo error. CT highly suggestive of COVID pneumonia. RTPCR negative . 1) Present trend seems to be to view CT findings as RTPCR equivalent . Clinical findings are suggestive of COVID 2) Simultaneous occurence of Covid and dengue are being reported .? Cross sensitivity To treat as Covid, repeat RTPCR If there is thrombocytopenia , platelet transfusion can be given .
Corads 2 suggest cOvid 19 infection. GGO present in bilateral side COvid 19 with dengue with severe thrombocytopenia. Prognosis not good Platelet infusion needed PT INR, D dimer Ceftriaxone 1gm bd Dexamethasone 8mg bd Remdesivir od Nebulization Control blood pressure and other vital
Bil basal confluent shadows seen. Few reticulonoduler opacities seen in bil parahilar region. Possibly covid pneumonia. Adv evaluation.
Rt pcr is false negative Here Dengue IgG positive suggest old infection
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Covid19 pneumonia 40 years old male patient (bank employee) with a history of coughing for 2 weeks, becomes febrile 2 days before presentation, the fever is responsive to acetaminophen, then chills and myalgia becomes apparent and he develops dyspnea on exertion. when he presented with ill-looking, fever and chills were significant, his vitals were PR 100, RR 20, peripheral O2 sat 85%, BP 140/90, sublingual Temp 39.5. He had DOE and on chest exam, he had coarse crackles all over both lungs. we immediately admitted this patient giving him nasal oxygenation by cannula, IV fluids, paracetamol IV administration , ABG was done pCO2 42, HCO3 22, pH 7.38, paO2 83. we requested a chest CT scan and yup , multiple patchy ground glass opacities infiltrating the peripherals, thus the patient was isolated immediately, multiple nasal swab specimens were sent for rtPCR. CBC was done . mild leukocytosis with no lymphopenia, no thrombocytopenia ... procalcitonin undetectable.. crp 2+ ... renal, hepatic and cardiac markers were all within normal ranges . the patient was then marked as covid19 pneumonia after the second rtPCR test.( first one negative) hydroxychloroquine 400 mg bid then 200 mg bid and azithromycin 500 mg stat and 250 mg daily were continued for 10 days ... no ECG abnormality was noted. the patient remained in a plateau phase, fever disappeared after 5 days, nasal oxygenation discontinued, only some mild dyspnea and mild cough were noted before discharge ( after 10 days) ... He was lucky, as i have seen people with this presentation undergoing intubation and have a poor outcome.
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sir...my father have fever on and off last 5 days...cough with expectorant ...BP.normal sugar normal spo2 97....tab moxikind CV 625 tab mountain lc...tab azee 500...tab dolo 500...given after taking medicine fever off.... and again fever comes...andgen weakness also..so blood test done pls suggest line of managment. @Dr. Shivraj Agarwal
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70 hypertensive,M,presented with dry cough, progressive dyspnea ,fever since 3 days,s po2 was 93%,o n 7th oct ,responded well to antibiotics, bronchodilators and antiviral with supportive therapy,and discharged. his serial cxrays,ct thorax films and lab reports enclosed. he has corse crepts since admission which are still persisted with dry cough.otherwise improved.what could be cause?plz discuss.
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