Concluded Case

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

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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

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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

Thanx dr Sandeep Ghodekar
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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

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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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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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

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

THIS CAN HAPPEN ASSOCIATION OF COVID AND DENGUE MAKING IT WORST FOR BOTH PATIENT AND TREATING PHYSICIAN

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