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
Treat as a covid pt
Bilateral basal opacification Typical of covid broncho pneumonia Double antibiotic,one of which should be azithromycin Decadron .i.v Neubolise Etc
Bil basal confluent shadows seen. Few reticulonoduler opacities seen in bil parahilar region. Possibly covid pneumonia. Adv evaluation.
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
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
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
Cardiomegaly Pneumonitis
NEED'S.. HOSPITALIZATION.. RESPIRATORY SUPPORTIVE TREATMENT.. PLATELETS.. MANAGEMENT AS PER PROTOCOLS.. FOR COVID-19..
Chronic pneumonitis ? Tubercular
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